relations

Clinic days are the days I feel most at home in medicine and also most out of sorts. This morning, it was my turn to present a difficult patient case to the rest of our primary care program. These cases are meant to discuss challenging patient interactions and personal management rather than clinical questions. As I narrated the one year course of a relationship with a patient who has presented multiple complex challenges for me, and listened to others' questions, thoughts, and suggestions, I felt the weight of this one relationship. I don't mean weight as a burden, though it's clearly been hard for me to navigate, but more objectively as an observation. In learning about one person there's a lot there, and also a lot of gaps in perception and understanding. It overwhelmed me to think about it.

Later that afternoon I had actual clinic, where I saw four patients. One of them asked how many I see in an afternoon, and I told him somewhere between four and six, and we commented on how that wasn't that many. But I always feel like it's a lot; each person is a different place and there's always so much to process. What strikes me is how much of medicine is about developing these relationships. You know this is a cliche beforehand, but living it is so different (also a cliche). What strikes me even more is how ill-prepared we are for developing them, especially at a place like the county hospital where the patients are so very different from the doctors taking care of them. I think of how much different life they have experienced, and how much of my time has been spent in books in order to help them deal with these lives that exist in a totally separate realm. M and I talk about this all the time, but now that I'm actually responsible for people, it hits hard the flaws in our book learning and even our patient-centered learning. But even as I flounder with it, I'm incredibly grateful to encounter so many diverse people, and to have a relationship even when unable to relate.