Making a better doctor, and better patients

What exactly did I think I was getting myself into? As I approached the Austin Convention Center’s loading dock, which was swarming with people, it felt like an enormous hospital—a hospital not only for the sick but also for the weary-hearted. I had come simply to see whether I could help other evacuees; I didn’t expect them to teach me a lesson in clinical medicine.

I had been living in New Orleans for only six days before leaving town. I never got the chance to start at Tulane’s School of Public Health and Tropical Medicine. Along with my landlord and his family, I rode out Hurricane Katrina in Houma, La., a predominantly Cajun town southwest of New Orleans. I awoke the morning after the storm, surprised that I’d slept through the brunt of it. Slivers of light invaded my room through boarded-up shutters. Lawn furniture, branches, leaves and other debris lay strewn across the backyard, and the gusting wind carried an eerie chill. What next? I asked myself.

When I heard of the devastation of New Orleans, I left my refuge to stay with friends in Austin, Texas. I volunteered to help at the convention center, which housed 4,000 evacuees: some riding the high of a miraculous escape, others succumbing to depression after seeing their homes and livelihoods swept away. All, however, were emotionally fragile.

I discovered their vulnerability while distributing toiletries and clothing to people lined up for showers. Grown women reluctantly asked me for clean underwear. They’d make a request, and I would search for the right size. Sometimes I had to turn back for a larger size, embarrassing the woman I was serving. One woman asked me for a feminine hygiene product and I wasn’t sure what she needed. I felt flustered and she told me to forget the request. As she walked away I knew I’d seriously messed up.

I did better when my job was to help elderly and disabled men at the showers. As I wheeled one man into the changing room, he recounted the story of a treacherous week. Together we peeled off his clothing one piece at a time: His legs wobbled as he hovered above the wheelchair. His soiled underwear dropped to his ankles, and I tossed the garment in the trash heap. Steam from the showers and the midday Texas sun cooked the air inside the shower room; the smell was nauseating. I had to fight the urge to rush outside for a breath of fresh air. The man’s eyes showed me his underlying feelings of humiliation. I knew that registering my revulsion would only make him feel worse. So I held back my feelings and told him how wonderful his shower would feel, hot water hitting his back for the first time in 10 days. Ahh.

It doesn’t take much to make a patient feel afraid or ashamed. Sometimes a reflexive shudder will do it. Or maybe a grimace or an unthinking remark. The consequences are serious. Once people are made to feel inferior or disgusting, they shut down. They’re not as likely to be open, honest or compliant.

I often thought about Austin after finding a home for the fall at the Yale School of Public Health. I began using my experiences there as a lens for understanding my classes. In the health policy course, for instance, Mark J. Schlesinger, Ph.D., professor of public health, explained how stigma can compromise the quality of health care. Patients with a stigmatized illness, he explained, are less likely to seek care. Furthermore, he told us, physicians are more likely to sidestep critical issues related to conditions that carry a stigma. My mind reeled back to the Austin Convention Center and I understood that when I embarrassed the woman who needed sanitary products, I had unintentionally denied her appropriate care. Later, my ability to overcome my discomfort with the man in the shower allowed me to help him without compromising his dignity.

I didn’t work in a hospital, help out in an ER or scrub for surgery, but in Austin I learned something about clinical medicine. I have promised myself that when I become a physician, I will remember the lessons the evacuees taught me about the importance of unabashed sympathy. I think those lessons will make me a better doctor and help my patients to be better patients.