麻豆区

When my son was very young and crying with a fever or because he was afraid of things that might be hiding in the dark, I'd hold him close and murmur comforting nonsense, things like "Hey, hubba bubba," or "Oh, sweet potato."

My son is grown now and no longer comes to me in tears. But one day at work, toward the end of a long day of patient care, three men in a row cried in the exam room, each having lost jobs, homes, and families to substance use. It was an avalanche of despair, and I was tired and empty. As I sat with the last of them, a burly, bearded man in his 40s, he said through his tears, "I'm just so sad. So f***ing sad."

I replied without thinking, "Oh, sweet potato."

He was quiet for a moment, then wiped his eyes. "Did you just call me sweet potato?"

I nodded and half-laughed, embarrassed. Then he grinned and laughed too, and we sat there, smiling at each other, each of us enjoying the moment's ridiculousness and, I think, its tenderness.

The philosopher and author bell hooks once wrote, "Rarely, if ever, are any of us healed in isolation. Healing is an act of communion." That is, healing requires connection. That was what I felt that day with that patient: an almost palpable connection, an energy shift, resonant and replenishing.

But connection usually requires time, and often, in medicine, we don't have enough of it.

As a medical student, I spent a month in Brazil on an infectious disease rotation. It was 1997. Antiretrovirals were finally bringing hope to people living with HIV, and the Brazilian government had guaranteed free and universal access to the medications for anyone who needed them. Every weekday afternoon, I sat next to a young physician in the HIV clinic and watched him wilt over the course of the day, seeing another patient, then another, then another. Aside from questions about condom use and symptoms, he asked almost nothing about their lives, fears, or hopes. He could sit and talk, or he could see five more people, five more who might survive.

Now I work in a rural hospital in Northern New Mexico, in a valley nestled between the Jemez and Sangre de Cristo mountain ranges, 30 minutes north of Santa Fe's wealth and about the same distance east of Los Alamos's secrets and PhDs. Over the past 50 years, drug and alcohol use has ravaged the valley. In response, our small hospital has created a comprehensive addiction consult service and outpatient clinic that draws patients from across the state. Even so, on some afternoons, multiple no-shows in our clinic give me time and time and time to spend with the patients who do come in. On those days, I can coo over photos of newborns, appreciate new tattoos, and celebrate reports of new jobs and new beginnings. I can also hear about terrible problems I have no way to solve. I can at least offer the gift of listening.

On other days, the volume of care is enormous, and I sprint between the consult service, the ER, and the clinic. If it's busy like this for only a few days in a row, I don't mind. In fact, I kind of like it; I know that when I have too many patients, it means people know about us and want our care. On those days, I zip in and out of rooms, feeling like a minor-league superhero, knowing that, like the doctor in Brazil, the most important service I can offer is the right medication at the right time. Also, sometimes I like not hearing about those unsolvable problems. Lack of time becomes a convenient escape.

But if it happens too often, I start to feel untethered, a stranger who doesn't remember anyone's name, and who doesn't know where they live, what gives them joy, or really any details of their lives, other than that they drink too much alcohol or use too many drugs. I've known this feeling before, in other places and practices. I know that when the feeling hits, I become tired and distant, and I am so, so relieved if the last patient of the day changes her mind and tells me no, she doesn't want any help after all.

I was telling my friend Jenny that I don't know how to solve the time/attention problem, the tension between serving more patients and knowing them less. Jenny is one of the best doctors I know, with a remarkable ability to uncover and celebrate the gorgeous and deliciously unexpected in almost everyone (whether they carve wolves as a hobby, toured with the Dead at the same time she did, or work as a shaman part-time). She told me she has a trick for "stretching time": she tells herself to focus fully on the patient in front of her for 5 minutes, just them and whatever they want to tell her. Five minutes, she reminded me, is nothing, but it is also so much longer than most of us usually get.

I know Jenny is right, but on a busy day, when I think about how much work is still left to do and how many people are still waiting, even 5 minutes of focus can be difficult for me to maintain.

But if bell hooks is correct and healing is communal, a lot can be accomplished in those 5 minutes. That encounter with my patient, the sweet potato, wasn't extraordinary to me because I thought I'd healed him. It was extraordinary because in that silly, tender, connected moment, I was replenished. He healed me.