Editor's Commentary on Dr. G

 , October 05, 2019

Often, in the hospital setting, we meet patients at a specific moment in the progression of a chronic disease. When we meet them late in that progression, their disease has become so debilitating that it has robbed them of parts of their independence, their cognition, and even their identities. In this carefully-crafted essay, Chen introduces us to a man who is early in his disease process. So early, in fact, that his firm handshake, easy stride, and sense of humor fool her into believing that he is “one of the staff” members. When we meet him next, however, he is “unable to hold up the weight of his own head.”  Though the amount of time that has passed is small, the disease has progressed quickly, and the person has changed substantially. Yet, he is still the same man. 

In many cases, physicians do not have the benefit of getting to know their patients early in a disease course. On initial encounter, it may seem as though all patients with a disease such as dementia are one in the same, as if they “have been shipped and assembled from a box.” However, if we take the time to learn about them, we are likely to find that a superficial exterior “brightens into warm, yellow sun…potted flowers and wild tomato vines.” We may find the person within each patient.

Chen, though she is still a student, alludes to one of the major barriers to forming a strong connection with each patient as an individual. Her choice of verbs gives us a sense of the time pressure under which we practice –summer “storms” in, and she is “whisked” into long days. “Nerves and pressure” build to the point of “clouding her perspective,” until “nothing mattered but work and tests.” She is so immersed in her pursuit of medicine that she stops visiting the veterans. In doing so, she misses a piece of Dr. G’s story, a segment of his trajectory, just as many physicians are compelled to focus on the pursuit of efficiency and productivity above the pursuit of a comprehensive understanding of a patient.

Sadaf Qureshi