Jonathan Xian
Houston, Texas, United States

At the start of residency, you should make a list of five things you value most and think carefully about which ones you can live without. Cross them off one by one until only one is left, and that one is what you get to keep. My one thing was Julie. I met her during my fourth year of medical school. We were both going through a transition, me from a medical student to young physician and her from a career in modeling to nursing school. As a student I had all the time in the world for late nights out, relaxed trips to art galleries, and vacations to anywhere we could drop a pin. We had three months of a blissful, young relationship until one morning when she mentioned that her neck was swollen behind the ear. I questioned her further, and it turned out the mass had been enlarging for months. As I heard this I felt a tightness starting in my chest. I knew the possibilities for a mass in that particular spot from my textbooks and that there was very real chance of cancer. Still, nothing in my books could prepare me for the next few months. I did not know how it felt staying up for hours worried about obscure malignancies. I had never experienced waiting on hold for hours each day with insurance companies hoping they would not deny your claim. Worst of all, I never realized how doctors sometimes fail to listen. “It’s like these doctors don’t care about what I say and just try to fit me into their boxes,” Julie would often complain, “I just feel like what I’m saying is lost in translation.”

To be honest, going through treatment with her, I felt that way too. I felt that way after her head and neck surgeon saw us for less than a minute and recommended two more months of observation and when the infectious disease specialist insisted on ordering the same serologies that Julie’s primary care doctor had already confirmed negative. I felt that way most of all when, in the middle of interviews, the doctor would cut us off or simply stop listening as soon as they had heard enough to order some tests. By the time the doctor translated what we said into medical terms, the meaning was sometimes distorted beyond recognition. During the months of workup, we felt our lives were suspended outside of normal time. I had often seen cancer’s gravitational effect in my patient’s lives, and now it was my turn. Two months and two head and neck surgeons later, someone finally agreed to a biopsy and diagnosed papillary thyroid cancer with localized metastases. I begged for an early surgery date, and the operation was done within the week, followed by radioactive iodine ablation a month later.

I started my intern year reassured by Julie’s clean scans and encouraging test results. I took pride in my role as emissary between Julie and our medical system and did my best to shield her from worry. I thought that if I just tried my hardest at the hospital, worked diligently at my research, and took good care of Julie I would have my dream life. But soon the early mornings and late nights of residency began. Julie and I had talked about residency and she knew it would be hard, so her complaints were quiet at first. Maybe there would be a sigh after another dinner missed or a few words about the old days when I didn’t have time to go out with her. Over time the complaints became clearer and more pronounced: I never talked to her about my day anymore, I never wanted to just sit with her and relax. I had become too high-strung to just listen.

At that time I did not understand what she meant. I still took her to all her appointments and dealt with the insurance companies. I even kept up with the latest research on papillary thyroid cancer. When it looked like her insurance plan might fold, I suggested we take a leap of faith and get married so she would not lose coverage. After all, we had already been dating for a year and half and been through more than most couples. She gave a thoughtful yes and we went to the courthouse the next day. I was as happy as someone could be post night-call. In my mind I was taking great care of her, but still she told me that I never listened. She confessed that sometimes I reminded her of the doctors who had brushed her aside when she was sick. That no matter what she said, the meaning was lost.

After three years together Julie filed for divorce. I did not understand what she was trying to say until it was too late. Looking back, I probably should have read a few less thyroid cancer papers and spent a little more time being present. I think as physicians, we tend to have too much faith in our own expertise at the expense of listening. We are taught in medical school to listen, but at the same time we are taught to redirect, refocus, manage the conversation. We are taught to use half our mind listening and the other half forming a differential. From this we gain the ability to discern a diagnosis from disjointed scraps of information, but perhaps we lose something as well. Too often, we treat people presumptively based on what we know rather than listening to the person behind the diagnosis. I hope to always take the extra moment to listen from now on. This way, perhaps the important things will not get lost in translation.