I met Monique when she came in seeking my supervising doctor’s help with depression and anxiety. Not an uncommon “chief complaint” at my medical student continuity site, I was caught off guard when the doctor shared Monique’s story in the seconds before he opened the door to greet her. I did not have a moment to digest her tale or to prepare myself for our meeting. I was relieved that the doctor skipped his canned “Benjamin-is-a-medical-student-with-me-today” introduction and immediately pulled his awkwardly small, physician chair closer to Monique in an almost knee-to knee position. I sought shelter in a corner of the small examination room. I did not want to be there, and I certainly did not want Monique, who I immediately liked, to have to be there. It felt like one of the longest patient encounters that I ever shared….
Fast-forward three months and Monique has returned to the doctor’s office to follow-up on how she is feeling and how she is tolerating the prescribed antidepressants. This time, though, I notice her name – my brain a second slower than my mouth – and blurt out that life has not been fair to her. I remind her doctor of my feelings about the man who inflicted her pain. In response, he sends me in to see her alone. Unlike any other clinical meeting, I did not want to be in there. Last time, the room was simply too sad and I had struggled desperately to prevent the moisture in my eyes from boiling over as tears.
After knocking on the door, I entered and found Monique seated. She had a new, more youthful haircut. I stumbled to find my voice and remember my name. Monique smiled hello. I had not seen her smile before. Her bright white teeth, framed by a damaged smile captured her status: A woman trying to look ahead while indelibly tied to the past; a smile of hope corralled by a scar of loss.
Monique confirmed that her medication was helping but admitted that she still became very sad sometimes. She relayed a recent episode: While driving, a song by Luther Vandross came on the radio. As soon as she recognized the tune, she started to cry and had to pull over and collect herself. I took my first real gamble and decided to use my own life’s experience to try and help Monique understand the long road of grief that she is traveling. Though I never told Monique about the death of my sister – the loss of my only sibling when she was 19 and I was 17 – that experience allowed me to help Monique understand that it was ok to be sad; that in fact, it would be strange if she was not sad. I also tried to teach her to be happy without guilt when those moments surprised her.
Our conversation became very fluid. She was, by all accounts, doing better. Her blank stare was gone and had been, at various moments during our encounter, replaced by a real twinkle in her large, puppy-like eyes. The empty affect had been replaced by tears and laughter. Monique was learning. She was doing better. She chose to live, and the living had started. Of course, when your husband and children have been murdered by a drunk-driver, and you have been left with traces of a traumatic brain injury and a scarred face, this would be only the beginning for Monique; part of the maze to healing.
I explained that letting tears flow when Luther Vandross sings a song that her husband once sang is good. When I asked about her husband’s ability to carry a tune, she laughed – a real laugh, and acknowledged that he was a terrible singer. Sensing something spiritual about this wonderful Jamaican woman, I cautiously talked about signs from something bigger than us. I never mentioned G-d or religion but we seemed to connect. She sensed where I was heading and asked me if I thought that Luther Vandross could be a message from her husband. Without a real answer in my arsenal, I bounced the question back to Monique, and she seemed pleased to think that it was a connection with her husband.
“We must combine the toughness of the serpent and the softness of the dove, a tough mind and a tender heart.”
Yes, our physicians must learn the gritty details of the human body, but they must also learn to be good listeners. They must be strong and feisty in the battle to fight disease, but they must also be tender and loving to those with broken souls.
As patients, we must demand that physicians be both the serpent and the dove. After all, Monique is counting on that.