Myasthenia Gravis (Narayan Chattergoon)

ASCM, mid-October. A new medical student nervously steps into the exam room, mulling over OPQRST, trying to remember the order to ask questions, and breathes a sigh of relief when he realizes that his self-made “cheat sheet” will help him through everything he has to ask.

The patient, Mrs. M, sits in the chair. She looks up weakly from her seat, to fleetingly acknowledge the medical student – another face in a long line of visitors for the day. The medical student greets the patient with broad smiles and the prepared speech of “Hi, my name is… and I’m a first year medical student.”

The (typical) questions begin. “So you had some pain?” “When did it start?” “What makes it better?” He takes a formulaic approach in an attempt to solidify the basics of his clinical interviewing. Somewhere during the talk, he hears that she has Myasthenia – something or other. He doesn’t hear it quite clearly, and will ask again later for clarification. It doesn’t sound like any disease he had heard of.

Most of the volunteer patients in ASCM are generally cheery. They always seem happy to come and see the students, training future doctors and giving them lessons that only patients can truly teach.

However, amidst the scribbling and the facts and wondering whether something is a pertinent positive or pertinent negative, the student takes a minute to look at Mrs. M, hearing the dull tone of her voice. It’s a demeanor that instinctively raises concern in the student’s mind as he knows the feeling he gets from Mrs. M is one that usually tells him that someone is in pain. Subsequently, there are feelings of confusion. IIs it appropriate to voice his concern? Is his concern even valid? Will he be insulting the dignity of the patient if he voices his strong intuition that she simply is not happy?

This reflection occurs in what seems to be a long silence, but actually only lasts for a couple of seconds. Perhaps there is another side to honesty – that while we must not tell lies, we should also express our true, constructive feelings to patients. Taking a chance, being sincere and completely honest, is the right thing to do. He wants to be someone who can help people and listen to them.

“Mrs. M? I just wanted to stop the interview for a second. I can’t help but feel that you are feeling down. If you’re uncomfortable with the interview, we can always stop. But if there’s anything on your mind that you’d like to talk about, I’d be happy to listen to you if you are comfortable with sharing.”

The medical student feels like a rookie stepping up to the plate for the first time. But despite his nervous heart rate and a soft gulp, he knew that this was a shot he had to take.

Mrs. M’s expression changes. Her sullen face is replaced by surprise and eye contact. Her face then softens as she begins to speak.

“As a matter of fact, things have been rough lately. Thank you for asking. Everyone is expecting me to do everything at home, and with my condition, it’s terribly difficult…”

Internally, the student feels relief and contentment and continues to lend an ear to Mrs. M. The hand that took fervent notes on a clipboard is now gently rested and open. Mrs. M’s tension begins to dissipate as she shares her story. The dull tone of her voice shifts into one that is conversational, as if speaking to a friend.

Mrs. M, at the end of the interview, smiles and thanks the medical student as another ASCM comes to a close.

On his way home, the student silently makes his own affirmation. “I should always be able to recognize, understand and take an opportunity to empathize with my patients. Being able to keep in touch with my empathic and emotional sensitivities will allow me to do this – thus, over this year and future years growing as a doctor, I should ensure that I do not become cold and indifferent. While the clinical knowledge will come, it is up to me to maintain an open heart and mind toward others.”

After all, he thought, this would always be the difference between care for Myasthenia Gravis and caring for Mrs. M.
——

With thanks to Paige Zhang for her input.
by Narayan Chattergoon

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