Trust is a delicate thing.
Those first crucial moments of trying to establish it.
Sifting through the words and the veneers, trying to find a person’s character, to find their heart.
Trust is where it all begins
-and ends.
There are two rooms down the hallway... 1/
Those first crucial moments of trying to establish it.
Sifting through the words and the veneers, trying to find a person’s character, to find their heart.
Trust is where it all begins
-and ends.
There are two rooms down the hallway... 1/
The first room is dark, blinds drawn.
My very first interaction with the patient begins with me introducing myself, and him saying two words:
“Go away.”
I’m young. I’m filled with optimism.
I want to help.
I’m going to use all my empathy skills, to-
“Just. Go. Away.” 2/
My very first interaction with the patient begins with me introducing myself, and him saying two words:
“Go away.”
I’m young. I’m filled with optimism.
I want to help.
I’m going to use all my empathy skills, to-
“Just. Go. Away.” 2/
Well, step one of empathy is listening. My presence is obviously not wanted here.
I’ll come back later, after I finish rounding on the rest of my list.
I close the door quietly, and move on.
I said there were two rooms down the hallway, right?
On to the next one. 3/
I’ll come back later, after I finish rounding on the rest of my list.
I close the door quietly, and move on.
I said there were two rooms down the hallway, right?
On to the next one. 3/
The patient in this room is warm and welcoming. His wife sits beside him, her eyes are kind.
They’re happy to see me. They tell me what’s going on.
We go through the rituals of the visit.
I explain the differential diagnosis, and my plan.
I answer questions.
I leave. 4/
They’re happy to see me. They tell me what’s going on.
We go through the rituals of the visit.
I explain the differential diagnosis, and my plan.
I answer questions.
I leave. 4/
Standing in the hallway, I briefly consider going back into the first room. I’m riding a wave of goodwill from the friendly patient I just saw.
But no, now isn’t the time. Too soon.
I go to see the rest of my patients.
A few hours later, I’m back.
I knock on the door. 5/
But no, now isn’t the time. Too soon.
I go to see the rest of my patients.
A few hours later, I’m back.
I knock on the door. 5/
“Go. Away.”
This isn’t going to work. I crack the door open a little.
“Look, sir, I need to talk to you.”
The room is dark, I can barely see anything. I reach for the light switch on the wall and I hear him sit up in his bed.
“No! Leave it off!”
I leave it off. 6/
This isn’t going to work. I crack the door open a little.
“Look, sir, I need to talk to you.”
The room is dark, I can barely see anything. I reach for the light switch on the wall and I hear him sit up in his bed.
“No! Leave it off!”
I leave it off. 6/
I step into the darkened room, and let my eyes adjust.
He sits up in bed, surrounded by a small fortress of his own possessions. A laptop. A stack of books. A blanket.
As if it might defend him from the enemy at the gate.
“I’m Dr. Tabatabai, the kidney doctor.”
“I know.” 7/
He sits up in bed, surrounded by a small fortress of his own possessions. A laptop. A stack of books. A blanket.
As if it might defend him from the enemy at the gate.
“I’m Dr. Tabatabai, the kidney doctor.”
“I know.” 7/
I ask if I can take a seat. He says no, so I stand at the foot of the bed.
The silence between us grows for a moment before I speak.
“So, ahh, I’m here because your kidneys are not working well-“
“And you’re gonna put me on dialysis.”
“No... I’m not.”
“Yeah, whatever.” 8/
The silence between us grows for a moment before I speak.
“So, ahh, I’m here because your kidneys are not working well-“
“And you’re gonna put me on dialysis.”
“No... I’m not.”
“Yeah, whatever.” 8/
As days pass, I keep seeing the two patients down the same hallway.
One remains charming and kind. One remains angry and defensive.
I find myself spending more time with the friendly patient, and feeling apprehensive about my time with the angry patient.
I can’t help it. 9/
One remains charming and kind. One remains angry and defensive.
I find myself spending more time with the friendly patient, and feeling apprehensive about my time with the angry patient.
I can’t help it. 9/
One of the hardest feelings to overcome is the defensive instinct.
It’s very difficult not to feel personally threatened by disagreement or argument, especially when you feel wronged.
Anger and fear can feel very similar, almost indistinguishable. And they can coexist. 10/
It’s very difficult not to feel personally threatened by disagreement or argument, especially when you feel wronged.
Anger and fear can feel very similar, almost indistinguishable. And they can coexist. 10/
There are no magic words and there is no magic formula.
There is no easy bond forged with every single patient, no shortcut to connection.
Sometimes it just doesn’t happen.
But you have to be yourself. Be consistent. Stay true to yourself, your character.
And listen. 11/
There is no easy bond forged with every single patient, no shortcut to connection.
Sometimes it just doesn’t happen.
But you have to be yourself. Be consistent. Stay true to yourself, your character.
And listen. 11/
With treatment, and time, fortunately both patients improve.
Eventually they are both discharged home.
Nothing so far in this recounting has been particularly unique or memorable.
But it’s the goodbyes I remember.
Trust can be built so carefully, and shatter so easy. 12/
Eventually they are both discharged home.
Nothing so far in this recounting has been particularly unique or memorable.
But it’s the goodbyes I remember.
Trust can be built so carefully, and shatter so easy. 12/
The irate patient has warmed up a little to me over the days.
Maybe it’s because I’m persistent, or don’t become defensive, or don’t raise my voice to argue.
Whatever it is, he’s at least tolerating me by the end.
On the last day, something unexpected happens. 13/
Maybe it’s because I’m persistent, or don’t become defensive, or don’t raise my voice to argue.
Whatever it is, he’s at least tolerating me by the end.
On the last day, something unexpected happens. 13/
“Hey man look, just want to say sorry. I was just scared, y’know? I’ve known people on dialysis and it ain’t pretty. You took care of me, and ... yeah, thanks.”
I nod, “No apologies needed.”
The next time I see him is weeks later, in clinic.
He’s still gruff, but smiles.14/
I nod, “No apologies needed.”
The next time I see him is weeks later, in clinic.
He’s still gruff, but smiles.14/
Across the hallway later on, I say goodbye to the other patient. He thanks me profusely, charming to the end.
As I get up to leave, his wife asks if she can speak to me.
She takes me aside.
“Doc, I got a small favor to ask.”
I nod with a smile, “Sure.” 15/
As I get up to leave, his wife asks if she can speak to me.
She takes me aside.
“Doc, I got a small favor to ask.”
I nod with a smile, “Sure.” 15/
“I just feel like when we leave here, we’d like to see... ahh... an American doctor. It’s just, you know, for comfort. We, the family, we’re just used to ... you know.”
Her look is apologetic, kind, except now I know.
I was born in Baltimore.
I nod and say nothing. 16/
Her look is apologetic, kind, except now I know.
I was born in Baltimore.
I nod and say nothing. 16/
Every instinct I have is screaming that I should say something.
So I ask a question.
“Was there a problem with your care?”
She shakes her head almost violently, “No! It was fine! Fine! It’s just... you know. For our comfort.”
Both the patient and his wife smile, warmly.
So I ask a question.
“Was there a problem with your care?”
She shakes her head almost violently, “No! It was fine! Fine! It’s just... you know. For our comfort.”
Both the patient and his wife smile, warmly.
• • •
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