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Chest Pain, Resolving

One of my most moving experiences during residency happened late one night when I got a page from the emergency department about a new admission for chest pain.

I walked in to the room to find a loving elderly couple. I couldn’t help but smile as I witnessed them giggling and flirting like teenagers.

“Hey, Mr. Abbassi. I’m the on-call resident who will be taking care of you tonight. How are you doing?”

The cute old man suddenly changed personas and turned into yet another hard-to-please attending.

“It is actually Dr. Abbassi. And never ask a patient in the ER how he is — how do you think I am? I am sick.”

“Oh, I never even thought about what I was actually saying — that is so true. I am sorry, sir. I hear you are not feeling well. How can I help you feel better?”

He and his wife smiled at each other, and he continued to tell me his history of presenting illness. For most of residency, this was usually a very dry part of my “doctoring.” I would ask mundane questions over and over again until I grasped the concept of a few key diagnoses that people come to the hospital for. But with more than two and a half years of experience under my belt, and all the confidence of a seasoned expert, I am now able to turn the history into a rich conversation with my patients. So by the time he finished telling me what brought him to the hospital, we became old friends.

Dr. Abbassi is a retired physician who traveled here 45 years ago from Iran. He is generally fairly healthy, but in the last few months, he has been having intermittent chest pain and finally decided to get it checked when his wife started to get concerned. I smiled and made a joke about how sweet it was that it was because of his wife that he really decided to get his symptoms checked.

He looked at her, held her hand, and said, “She’s the love of my life. I listen to everything she tells me.”

I was in awe.

“Okay, I am pulling up a chair for this one. Please tell me your love story.”

He laughed and said, “Is this going to help you diagnose me?”

I responded, “No, sir, this is going to help me to alleviate your suffering.”

His wife smiled and said to him, “Do as you are told. It looks like they are finally training young physicians to pay attention to what their patients need.”

And he obliged without hesitation. He explained to me that his wife was a nurse at the same hospital where he did his medical training. He fell in love with her as soon as he caught a glimpse of her unique and exotic purple-blue eyes. He made a joke about how she used to wear a headscarf to cover her hair because she knew that her eyes would be highlighted. I laughed and gave his wife a high-five. I told her that I actually learned how to do eye makeup when I did my surgery rotation in medical school, because the only thing I could show off while wearing those masks and caps were my eyes.

But then I looked at his wife, and her long silver hair was down. He noted my confusion that she wasn’t wearing the religious headscarf. And all of a sudden, he started tearing up.

The atmosphere in the room suddenly changed, and I started to get worried. I asked, “Sir? Is everything okay?”

“No. My heart is hurting,” he stammered.

I immediately paged the nurse to bring him his cardioprotective and anti-anginal medications stat.

I looked over at his wife, who was in tears herself. She could see that I was confused and she slowly explained to me that she was scared that if she wore her scarf over her head, it may negatively impact the care that her husband received.

I just stared blankly at them both, blindsighted and with no idea what to say. I immediately started to think about the irony of witnessing a Muslim woman feeling forced to remove this garment. I started to tear up as I considered what “religious freedom” is supposed to mean. When he saw me getting emotional, Dr. Abbassi became infuriated.

“So . hat are you going to do? Every time you hear a patient telling you their story, are you going to get so sad that you forget to take care of them?”

Doctors are really good at that, you know? Getting deeply emotionally wounded and then shaking it off right away. I wasn’t so good at that skill just yet. So as the nurse walked in with the medications, he said in a huff, “No. No new medicines.”

The nurse looked at me exasperated. I knew exactly what she was thinking: “See, this is what I deal with when I page you in the middle of the night and you get annoyed at me.”

Dr. Abbassi knew the look all too well, given his wisdom of experience. He told her, “Leave the medicines here and go do your work. I want this young doctor to convince me to take them.”

And he went on to ask me why he should take these medications. “Explain why this medicine would work to make my heart stop hurting? What would aspirin do to protect my heart? How are platelets related to this? How does slowing my heart rate help? Why would someone need a cholesterol medicine acutely? How does that protect me if I have a thrombus or a clot right now?”

He would only give me a few seconds to answer a question and if I hesitated at all, he started to hum the song from Jeopardy. By the end, all three of us were laughing again. Finally, he said, “Okay, you convinced me. Now, tell me which pill is the statin?”

He stumped me. So I had to run out and ask the nurse to show me. He had a disappointed look on his face, “You should know which pills are which. You are the doctor.”

He could see me furrowing my eyebrows, annoyed that he wasn’t proud of me for getting all of his questions right. He said, “But, keep this up. Understand medicine deeply and understand people deeply. If you keep doing that, you will know a lot, explain a lot, help a lot, and save a lot. This is how to fix medicine in America.”

And then his wife explained, “And always listen closely to every person’s narrative.

Everybody has a story.

I’m telling you this as a seasoned nurse:

Every man who comes to the hospital with vodka on his breath
is in pain deeper than any lab test can show.
Every “Spanish-only” patient struggling to express her symptoms
has probably been through more in her life than there are words for —
at least in the English language.

More often than not, your patients are suffering
from something far more complicated and difficult to cure
than a physiological disease.

And it’s okay if you can’t solve the actual problem —
don’t burden yourself with such an unreasonable weight.
But — do this. Just do what you did today.
Because, Doctor — today, for this transient moment, you did —
you healed two broken hearts.

consci/o- [in medical terminology: a connection deep to a state of understanding]

All physicians are taught to communicate with a fundamental language of healing and justice. This column is a collection of reflections on how I learned this fundamental language and an homage to the teachers who taught me.

Srijna Nandivada, MD Srijna Nandivada, MD (4 Posts)

Resident Physician Columnist

University of Texas Health Science Center at Tyler

Srijna is an internal medicine resident physician at UT Health Northeast.

consci/o- [in medical terminology: a connection deep to a state of understanding]

All physicians are taught to communicate with a fundamental language of healing and justice. This column is a collection of reflections on how I learned this fundamental language and an homage to the teachers who taught me.