*A fictional column. All patients are composites. This is reflection, not medical advice. Full disclaimer at the end.*
—
Monday. 7:51 AM. Clinic was supposed to start at 8.
She is standing in my office at 7:51, which means she arrived at 7:48 and waited outside for three minutes deciding which exact second is acceptable on a first day. She has, I notice with some private tenderness, brought two pens. The second pen, in case. I have a drawer of pens. The drawer is older than her training.
“Good morning.”
“Good morning, doctor.”
She does not call me by my name. She has decided, in the way new fellows decide, that the safest address is the one that gives me nothing to correct.
I show her where the coffee is. I do not show her how to make it because the machine is, in the kindest description, a personality. It produces coffee under certain conditions known mostly to itself. She nods, very seriously. She writes it down on a small notepad I now notice she also has.
The first patient arrives. The first patient is the test, I tell her. She nods again. She does not yet know what the test is. She will, by the end of the morning.
The first patient is easy. A woman with an old condition, well controlled, who has come for her three-month check, and who, on noticing the fellow, brightens visibly. People are generous with fellows. They are kind to them in a way they have stopped being kind to anyone else in the building. The patient tells the fellow about her grandchildren before I can move us back to the lab work.
I let it happen. I have, over the years, learned that the first patient on a fellow’s first day is not really a clinical case. The first patient is an introduction, by the patient, to the kind of doctor the fellow is going to be. If the fellow listens to the grandchildren, the morning goes one way. If the fellow does not, the morning goes a different way.
She listens. She listens with her face turned, slightly, toward the patient. She nods at the right places. She does not write down the names of the grandchildren, which is a small mercy.
When the patient leaves, the fellow turns to me. “Was that okay?”
“Yes. That was almost the most important part.”
She does not understand. She will. By Thursday.
—
11:33 AM. A man in his forties with a long list of complaints, none of which, in isolation, are concerning. He has decided that the list, taken as a whole, is concerning, and has come for what he calls “a comprehensive opinion.”
The fellow sits beside me. I can feel her taking notes. She has, I imagine, written the chief complaint, the list, and the request, all in slightly nervous handwriting.
I do what I always do with this kind of list. I read it slowly, out loud, with the patient. I name each item. I ask, after each, whether this one is the worst. He says they are all about the same.
I then ask, “If you could only fix one of these, which one would it be?”
He looks at me. He looks at the list.
He says, “The sleep.”
We talk about the sleep for fifteen minutes. The list dissolves, gently, into a man whose sleep has been bad for two years. He leaves with a referral for that, and a follow-up in six weeks, and a small note on the discharge sheet that says “address sleep first.”
When he is gone, the fellow turns to me.
“You only asked him about one thing.”
“I asked him to choose.”
“He chose one.”
“Yes.”
“Is that allowed?”
I think about the question.
I say, “It is the only thing that is allowed. People do not have eleven problems. They have one, that they have, over time, learned to describe in eleven ways.”
She writes that down. I almost stop her. I do not. Let her have it. It is not a bad sentence to carry around in a pocket on a Monday.
—
At 1 PM the fellow and I eat in the small back room, which has, for reasons no one has explained to me, a fridge but no kettle. She has brought her own lunch in a small reusable container of the kind that suggests someone in her life is invested in her eating properly. I do not ask who.
I ask her how she found the morning.
She says, “Harder than I thought.”
I ask which part.
She says, “The listening. I thought I knew how to listen. I have been listening for thirty years.”
I say, “We have all been listening for thirty years. None of us is finished.”
She nods. She eats the lunch slowly, the way you eat when you suspect someone might ask you another question.
The afternoon clinic begins at 2. She washes her container in the small sink. She puts it back in her bag carefully, as if it might break. She picks up the second pen. She follows me into the corridor.
Somewhere in the building, the printer is making the sound again.
—
**Disclaimer**
Doctor’s Diary is a work of fiction. All patients, conversations, clinical findings, laboratory values, treatment decisions, and outcomes described in this column are invented composites. They do not depict any real individual, living or deceased. Any resemblance to a specific person, encounter, or institution is coincidental and unintended.
This column is published for reflection and literary purposes only. It is not, and is not intended to be, medical advice, a clinical opinion, a diagnosis, a treatment recommendation, or a substitute for professional medical evaluation, examination, or care. Nothing in this column establishes a doctor-patient relationship between the author and any reader.
Do not start, stop, change, or interpret any medication, test, diet, lifestyle measure, or clinical management on the basis of anything written here. If you have a clinical concern, consult a qualified healthcare professional in person. In an emergency, contact your local emergency services immediately.
The author writes anonymously. The views expressed are personal literary reflections and are not official guidance from any institution, regulatory body, hospital, university, professional society, or government agency. Information may not reflect the most current medical consensus, guidelines, or evidence and is provided “as is” without warranty of accuracy, completeness, or fitness for any particular purpose.
The author, Hormone Insight, and its operators accept no liability for any action taken, or not taken, on the basis of content published in this column. By reading this column you acknowledge and accept these terms.
