Barely into my second year of medical school, I already have a reputation — I love asking the uncomfortable stuff. Social history, sex, drugs, alcohol, I want to know it all. At first, it was just because that section randomly fell on me during small group sessions or standardized patient encounters. Then, I began to volunteer, or be volunteered. “Mariya loves the dirt,” my classmates say.
Without saying, I always approach this section of the interview with the finest nuance of word, a neutral demeanor and utmost professionalism. However, my propensity toward asking these questions and knowing their answers highlighted a palpable sense of curiosity that my classmates and preceptors could feel. A long-time friend and dental student proposed that it’s the housewife in me — seeking something juicy and novel in the lives of others to stir up the occasional banality of my own existence. Maybe, but to her fortune (or perhaps misfortune), her patients’ mouths are far too occupied to talk, so I did not find her observation to be entirely objective.
Then, I thought about conversations with my father, who as a former medical examiner, saw the most atrocious and horrific ends to people’s lives. I often asked how he could remember his experiences without dwelling on the disturbing memories of these events, how he never became consumed with their suffering or the sheer effects of seeing such unsettling things. Instead, with his impeccable and jovial humor he could recount cases that would land most people in psychotherapy. His answer was that he always saw the bodies as objects of his work, always with an emotional distance. For him, practice was all science; for me, practice is all feelings. I guess that’s why he’s a pathologist and I spent four years studying psychology.
My curiosity for those uncomfortable questions is partly about getting closer to the patient emotionally. However, it’s not just in being able to elicit a relationship of comfort and trust, but also in helping me better care for my patients. Patients are not just biological machines with errors to fix. After all, radiating chest pain and cough with sputum is not what makes someone a human being. What makes them human is that they are flawed, fallible and subject to a vast range of emotions. In the long run, isn’t that what we’re here to do? To heal pains of the human experience?
My asking of these questions in itself is part of the healing process for my patients. Without doubt, the sheer catharsis of sharing personal troubles with an unbiased party is therapeutic alone. At the same time, by becoming curious about your patients, you open the door to address their heroin use, impotence, unsafe living conditions or other issues too crippling to offer up voluntarily. It allows you to offer them at least the hope of someone understanding and being able to help. By asking these questions you find out that the noncompliant patient is terrified of medications because she accidentally overmedicated and killed her infant son, or that the “frequent flyer” is ailing from a broken heart. Most importantly for me, the “dirt” breaks the coldness of the sterile medical environment and impassions me to heal these people, not as objects of my work, but as humans.