The wizen-faced, abuela with long, curly, grey-black hair tucked neatly up in a bun pursed her lips as she concentrated through tightly shut eyes, trying to tell whether we were pricking her with the sharp or dull side of a Q-tip.
“Dull, dull, sharp.”
Her 7-year-old granddaughter giggled when grandma “got it wrong”, as we tested toes no longer able to even sense when they were being touched, a product of uncontrolled diabetes.
We completed the exam and Carlos, my fellow student examiner, smiled reassuringly: “No te preocupas; hablaremos con el doctor y regresaremos pronto.”
We left the room and his encouraging smile melted into worry: “She is really sick. Really sick.” I bit my lip and nodded.
It was turning into an extra-long day at St. Vincent’s student clinic. Saturday shifts are supposed to be 10-2, but close to 4pm, we were still processing new patients. The Junior Directors (3rd and 4th year med students) were pulling their hair out, trying to guide us younger students, help the patients, fix non-working printers (which our junior director says he doesn’t get paid enough for), dispense new prescriptions, and review all our patient notes as quickly as possible. Everyone had exams or long clinic days coming up. Everyone wanted to go home.
Carlos and I waited our turn until a faculty physician was ready. We described our patient, with her long, long lists of problems. The physician listened intently, “Well, that’s quite a list, isn’t it?” We nodded.
“We can help her, but we can’t do everything today. It’s going to take some time and patience. Tell me something: if you could help her today with just one problem, which is the most important one today?”
It was a good question, one he repeated to the patient when we went back into the examination room for the doctor to review our work. After some discussion, we settled on a treatment plan, worked with her on the first steps, and scheduled a follow-up appointment.
As we worked through her note, dispensed her medications, and finally wrapped up to head home, that question continued to ring in my ear: “You can’t do everything…but if you could change one thing, what is the most important one today?”
I think all of us have things we wish we could change. (As the random English major who usually feels the absolute dumbest in the medical classroom, I sure do….) Bad habits. Weight or appearances. Frustrating life situations. Poor grades. World events. Relationships. Grades. And honestly, some of them are things that we COULD change. We know that. But more often than not, we sit back, overwhelmed at how long the list to “change” is, and we end up doing nothing.
What if we picked just one thing at a time?
That same day at St. Vincent’s, we saw another patient. He was just coming in for a simple refill on a hypertension medication. Looking through his history, I could see that he had struggled in the past when he first came in with cancer, major depressive disorder, and prostate problems. I was amazed to see how far this man had come in just a few years.
I mentioned it to a faculty, and he nodded: “Yeah, Mr. X is one of my favorite patients. I say thank you every day I get a Mr. X, because he gives me hope. He isn’t inherently healthier or better than any other patient that comes in, but he sticks with it. He works through things one at a time. And now he’s in a better place. Man, I would give a king’s ransom for more patients like Mr. X.”
If you could make a list of all your problems, but just work on one at a time, how far could you go? If we’re like Mr. X, probably a lot farther than we are today. One day, one problem at a time.