The Yale Journal for Humanities in Medicine    

Thirty Minutes

Kristen Georgi, MA/MAT
kristen.georgi@dowdenhealth.com

I looked forward to spending the afternoon in the emergency room. Not as a patient, but as a shadow. I was to observe a doctor at work as part of the practicum for my degree in medical humanities at Drew University. As far back as I can remember, I loved to pore over my uncle’s medical books, until I came to understand that it was the books I loved as much as the medicine. Instead of becoming a doctor, I became a medical writer and editor. Unlike most other programs in this nascent field, Drew’s program teaches from the perspective of the humanities rather than the perspective of medicine; when I found Drew I knew had found home.

That day in the emergency room of a small community hospital in New Jersey, a multiple motor vehicle accident sent the staff into high alert, and my inquisitive presence became an inconvenience. I was handed off to John, a second-year resident in internal medicine who was seated behind a stack of open textbooks, preparing to take his boards. John was told to let me spend thirty minutes with him during his daily rotation at the clinic. True to my calling, I kept detailed notes that I present to you here.

***

The waiting room of the clinic is filled beyond capacity. John takes the chart out of the file holder and goes to the waiting room to get his first patient of the afternoon, a 54-year-old man complaining of stomach pain. He is on medication for acid reflux, but it isn’t helping him. He is also on an antipsychotic for schizophrenia. He has no family, was homeless for about a year but just got a place to live, he says. John’s face doesn’t register any reaction as he listens to the details of this patient’s life. He only allows himself to be concerned with the health of the patient’s body.

John tells the man to lie on his back, then palpates his stomach and raises his left leg swiftly to assess the stomach pain. The patient cringes; he is also on medication for chronic pain from a knee injury. He has a pin in his knee with a scar to prove it, which he now shows by rolling up his pant leg.

“Why are you here?” John asks several times. He is looking for a consistent answer. “I’m here because my stomach hurts,” the man says. John obliges by treating the patient’s acid reflux, writing a prescription for a higher dose of Nexium. He glances at his watch as he writes in the chart; ten minutes have passed since this patient entered the examining room. Stomach pain is easy. How do you fix a life in ten minutes?

John goes to the waiting room and returns with the next patient, a 63-year-old woman with white hair pulled back into a ponytail. She says she has had the flu with fever and diarrhea for several days, and hasn’t been able to eat. “You look good for your age,” John tells her. Her skin is smooth and pink, but her eyes show the poverty and loss she has endured. “I don’t feel good,” she answers.

The patient’s husband, a blue-collar guy with an upturned moustache, has come into the examining room with her. “You have hypertension and hypercholesterolemia,” John says to the woman. She understands the medical terminology and agrees; she is on medication for these disorders. John tells her that she needs 100 mg of her cholesterol medication instead of the 50 mg she has been taking, and begins writing a new prescription. “Can’t I just take two of the 50s?” she wants to know. “It’s cheaper that way.” John keeps writing. “We get better compliance if you take one pill,” he tells her.
But high cholesterol isn’t her complaint today. Her problem is the flu, and persistent pain in her left shoulder, and feeling down in the dumps. She shows how the shoulder pain limits her range of motion. The x-rays taken last month aren’t in her chart. “Can I get an MRI?” she asks. “I take Advil for the pain but it doesn’t even touch it.”  John thinks she should have the MRI, but first has to consult with the attending in charge.  Flu, high blood pressure, high cholesterol, shoulder pain. He leaves the room, comes back, and writes an order for the MRI.

“Maybe she’s just worried because I’m having surgery for a tumor on my bladder next week,” her husband says. John doesn’t answer. The woman is his patient, not the husband.

The waiting room has gotten even more crowded, if that’s possible. The next patient is an elderly woman in a torn brown sweater who carries a large plastic bag. She sits on the examining table, opens the bag, and pours medicine bottles onto the table beside her.  John looks at the chart. It shows that the patient is an unstable diabetic. It also shows that she has a Russian name and doesn’t speak English. John has picked up a little Spanish, but not a word of Russian. He tries to talk to this woman, who becomes increasingly frustrated as she tries to answer. Finally, it is clear. She’s saying, “Where is the Russian doctor?”

The Russian doctor isn’t in today. John picks up the receiver of the wall phone and requests a Russian translator. He does this twice, because twice the connection fails. Finally, the translator’s voice crackles into the air, asking the woman how she is feeling. She has come to the clinic today because something about her medication isn’t right, the translator explains. John tells her, through the translator, that she needs to get her eyes checked every year. The woman jumps off the examining table and yells at the phone. The translator’s voice repeats her words in English. There is nothing wrong with her eyes! She lives far away and would have to ask her son to take off from work to drive her to the eye clinic! There is a problem with her medicine, not her eyes!

The phone line goes dead again. The woman doesn’t understand that because of her poorly controlled diabetes she runs the risk of losing her eyesight. Because of the language barrier, John can’t explain. He has spent fifteen minutes and gotten nowhere. He goes to get the next patient.

There are so many more patients waiting. There are so many more hours before his shift in the clinic is over. It feels hopeless. It feels endless. John has put his books away. Minute by minute, patient by patient, he is learning to become a doctor.

About the Author

Kristen Georgi is a doctoral candidate in the medical humanities program at Drew University.

Published: December 19, 2007