Koki Kato is a GP, educator, and GP practice director in Japan with interests in medical generalism and narrative practice. He is on BlueskyStill, she kept coming.
I listened, examined her, reconsidered what we might have missed, and tried different approaches. I also tried to understand the pain in the context of her life. Over time, her world had become smaller, shaped by loss and increasing isolation. We talked about these things and how they might relate to her pain, but our conversations rarely seemed to go anywhere new. Again and again, we returned to the same place: the pain was still there, it was distressing, and she wanted to know why.
Again and again, we returned to the same place: the pain was still there, it was distressing, and she wanted to know why.
Once, feeling particularly helpless, I asked her, ‘Do these visits help at all?’
She paused. ‘I’m not sure. But somehow I feel a little better after coming here.’
For a moment, it seemed that these consultations might mean something after all. But the moment did not last. At subsequent visits, she continued to tell me that the pain had not gone away. She was still distressed. She still asked why. I continued to feel that I had little to offer.
I knew that healing could occur even when symptoms did not improve. I also held to a principle of family medicine: an open-ended commitment to patients, including when there was little we could change. These ideas gave me reasons to continue seeing her, but knowing them did not make the experience any easier to bear. The consulting room can feel like a closed space. The patient and I sat opposite each other. She brought her pain and her questions; I had a responsibility to respond. When little changed over many consultations, I began to feel alone with my own helplessness.
Perhaps, within the consulting room, I was. But the consulting room is not the whole of my world. Beyond it are people with whom such experiences can be shared. I work alongside other GPs. I supervise trainees, and I have GP friends in the UK with whom I exchange experiences of practice. These conversations rarely solve the problems I bring to them. Often they are quite ordinary. Yet sometimes it is enough to recognise that an experience I had thought of as mine is also known by others.
Carrying something alone is hard. Perhaps being connected to others quietly helps us to carry what remains ours to carry.
My family is different again. Around a table with them, we eat the same food and talk about it — sometimes simply saying how good it tastes. There is nothing remarkable about these moments, but they are part of what connects us. I am a son, a brother, a husband and a father. I am simply there, among people to whom I belong.
Carrying something alone is hard. Perhaps being connected to others quietly helps us to carry what remains ours to carry.1And perhaps ordinary relationships are also part of a healing landscape.2 I wonder whether these connections are part of what allows us to remain when little changes. She kept returning. And I kept receiving her.
The helplessness remains. I suspect it always will. But I am not alone with it.
*Author’s note: The patient described in this essay is fictional and is based on the author’s clinical experiences.
References
- Bub B. The patient’s lament: hidden key to effective communication: how to recognise and transform. Med Humanit.2004;30(2):63-69.DOI: 10.1136/jmh.2004.000164
- Miller WL, Crabtree BF. Healing landscapes: patients, relationships, and creating optimal healing places. J Altern Complement Med. 2005;11 Suppl 1:S41–S49. DOI: 10.1089/acm.2005.11.s-4
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