Palo Alto, California, USA
|Christ sits at the bedside of Jairus’s sickening daughter. Etching after G.C. von. Max.
Credit: Wellcome Collection. CC BY
“It’s for you,” the old man said when his niece tried to hand Dr. Alba the large wrapped package. It was a gesture I was familiar with, though Dr. Alba looked puzzled. “These scratchy hospital blankets made me think of this,” the patient, Clark, continued. “It’s a good blanket; my wife made it a long time ago and she would have appreciated you taking care of me. She would want you to have it.” Though his eyes shone with tears, he had an expression of fond anticipation at being able to offer Dr. Alba something that was clearly so meaningful.
“That’s thoughtful of you,” Dr. Alba said, and I could tell he was choosing his words carefully. “I truly appreciate the gesture. I am not, however, able to accept any gifts.”
His family members winced, but the patient continued, undeterred. “Nonsense. I want you to have it.” His smile was at first rueful, then sly. “Haven’t you heard of patient autonomy and choice and all that?”
“I certainly have,” Dr. Alba said, “which is why I want to talk to you about your most recent labs.”
The disappointment on the old man’s face was unmistakable.
Clark’s gesture was familiar to me because I had witnessed it so often while growing up. Gorgeous pieces of hand-thrown pottery. Exotic plants. Intricately-woven scarves and hand-knitted sweaters. Even a samurai sword — these are not the sort of thing one might expect to receive as a healthcare provider. But for my father, an ophthalmologist in Taiwan, such items were common gifts from his grateful patients.
Throughout my childhood, I saw my father bring home a seemingly endless array of unique and highly personal offerings; it was clear his patients had a heartfelt desire to demonstrate how much they appreciated having their eyesight — often the most cherished of the senses and a frequently overlooked component of their wellness — restored. It was not uncommon for my father to refer to some of his patients as friend, and these patients, likewise, thought the same of him. My father never called attention to the intimacy, trust, and mutual respect he established with his patients, yet it was still abundantly clear, even to the casual observer, that this was the type of medical professional he was: someone who had an intuitive understanding that the whole person could not be ignored.
Many years later, I find myself as a medical student in the United States, immersed in a very different ethos of provider-patient relationship. “Clinical professionalism” seminars at school warned us against disclosing personal information, such as phone numbers or social media accounts, and especially eschewed the idea of accepting gifts from patients. We roleplayed using the “right words” to maintain proper distance with patients. As one of my professors, Dr. Schmidt, whom I greatly admired for her seemingly limitless medical knowledge, stated, “We’re not there to be anyone’s friend; we’re there to be their doctor.” The perils of not adhering to this advice were laid out both for the physicians — inhibited or impaired clinical judgment, burnout, compassion fatigue — and for the patients — unreasonable attachment, unreasonable expectations, unreasonable demands. According to this line of thinking, even a slight attempt to close the professional distance would risk the patient developing an onslaught of unreasonable behaviors, which the physician would then have to handle.
This was in striking contrast to what I observed back in Taiwan. My father and his colleagues never seemed to experience the compassion fatigue our professors issued stark warnings about. Naturally, I have wondered whether I am interpreting my recollections through a lens of naiveté. I am only a medical student, after all, and still have a long way to go before taking on my clinical duties. Perhaps I, too, will soon realize that establishing this sort of deep relationship with patients is ill-advised, if not impossible, once I have a full caseload of patients presenting with their own unique complexities.
And yet, I know what I heard and saw for myself in Taiwan. Not only did close relationships with patients — with gifts and all — improve the care the patient received, it also made my father and his colleagues’ jobs all the more interesting, satisfying, and meaningful. If anything, it helped reduce compassion fatigue.
Clark was a clear example of that.
I met him during my first year, as I rounded alongside Dr. Alba, a young geriatrician. Clark was one of his many patients and was recovering from a myocardial infarction. We were there to follow up on his most recent lab results, and, as we arrived, we found several people already in the room with him.
“Dr. Alba!” the old man exclaimed. “Welcome back to my temporary home!” He gestured to the four people sitting in chairs next to his bed and introduced them — his niece, her husband, and his two sisters. Then the man turned his attention to me.
“I don’t know who this fine young man is, but we’re about to find out.” He smiled, waiting for me to jump right in with an introduction of my own.
“Nice to meet you,” I said. “My name’s Henry and I’m a first-year medical student, working with Dr. Alba.”
The man’s smile remained, a hint of a mischievous gleam in his eye. “So is it Mr. First Year or Dr. Medical Student?”
His family burst into laughter, and I chuckled at the quip; Dr. Alba, though, skimming through the electronic chart on his tablet, cracked a smile without looking up. “Henry will be working with me on your case for the remaining duration of your treatment, Clark.”
Clark beamed as if this were the best news of the day. “Well, Henry, you’re about to see firsthand why it pays to keep at it and be a real doctor!”
As if on cue, his niece rose from her chair and retrieved a tote bag that had been at the foot of the bed. She extracted a large, bulky package wrapped in crinkled green paper, topped with a large blue bow, and held it out to Dr. Alba.
As Dr. Alba looked at it hesitantly, my mind briefly flashed back to the many instances I witnessed patients offering my father tokens of their gratitude, and the care and appreciation with which he received them. I understood why Dr. Alba felt he could not accept such a gift, yet the disappointed look on Clark’s face made me wish Dr. Alba could have made an exception, just this once.
Three days later, an hour before he was to be discharged, I found myself back in Clark’s room. The package — still wrapped — sat on the window ledge amongst a colorful array of flower arrangements and his personal belongings.
“How are you today?” I asked.
“So, what is it?” He peered at me through his wire-framed glasses. “Lice? Scabies? Some other sort of bug I’ve never even heard of?”
I blinked. “What?”
“Why the hell won’t the doctor take the blanket my wife made? Because he thinks it’s infested with bugs or something? It’s not, I can guarantee that.”
“Oh,” I said, immediately thinking about my father and how touched he would have been to receive something so precious from a patient. “Um, no… We don’t think the blanket has scabies or lice or anything like that.”
“Then what is it, then? What are you so worried about? Who on earth doesn’t like a ‘thank you’?”
“I could take the gift and give it to Dr. Alba later.” The words were out of my mouth before I realized what I was even saying.
Clark brightened immediately. “That would be wonderful! Finally — someone who gets it!”
I was not sure what to expect when I took the blanket to Dr. Alba the next day, though there was certainly a part of me braced for a reprimand for not adhering to the professional distance mandate. I could already hear Dr. Alba admonishing me. But instead, as I entered the office his face brightened, much like Clark’s had.
“I know it might not have appeared that way, but I truly felt bad about turning down his gift. It’s just not something that is customary here.” He took the package from me and gazed at it affectionately for a few seconds. “But now here you are, giving me another chance to take his gift — and I’m grateful for that. In fact, I’m going to call Clark right now and thank him.”
The look on Dr. Alba’s face was familiar — I had seen the look on my own father’s face every time a patient offered him a gift out of gratitude.
A degree of discernment in regard to what will truly benefit the patient and the limits of their physicians is certainly necessary. And Dr. Schmidt’s remark in class was no doubt too austere to capture the approach by which most doctors actually practice in the hospital. Still, each encounter I have with someone like Clark makes me wonder just how much the dogmatic insistence on professional distancing and gift-spurning inhibits the cultivation of care-optimizing empathy and trust. When we, as providers, reject tokens of gratitude or shut off any personal investment in patients and their families, we are, in effect, rejecting a part of their humanity. And if we reject even a fraction of our patients’ humanity, how can we expect them to have faith in ours?
HENRY BAIR is currently a second-year medical student at Stanford University School of Medicine. He previously attended Rice University and graduated in 2017 with a Bachelor of Science in Biochemistry and a Bachelor of Arts in Medieval Studies. Born and raised in Taiwan, he is interested in cross-cultural communication in medicine as well as the intersections between medical care and literature. In addition, he is passionate about medical education, especially in end-of-life care and in improving the patient-physician relationship. He spends his spare time writing, painting, and playing the cello.