For a Bellevue Physician, Listening -- and Writing -- Are Key
New York City's Bellevue Hospital, founded in 1736, is the oldest public hospital in the United States. NPR's Melissa Block, host of All Things Considered, recently spent a day at the hospital to get a sense of one doctor's world, through her relationships with her patients.
Dr. Danielle Ofri is an attending physician in internal medicine at Bellevue. For her, poetry and literature are as much a part of the job as X-rays and pills. She's written about her experiences there in a new book, Singular Intimacies: Becoming a Doctor at Bellevue. It's a collection of essays about learning to listen to the narrative of her patients.
"At the end of a long day, your whole body aches," Dr. Ofri tells Block. "I think part of that physical ache is from holding all of those stories, because patients are entrusting you with their stories -- their pain, their life. For a lot our patients, they have no one else."
Dr. Ofri sees illegal immigrants, the homeless, people in limbo between shelters and rehab, as well as elderly patients desperately wanting to go home, but who have no one to take care of them. Their sufferings are intense. On the day of Block's visit, there are patients with neurosyphilis, end-stage kidney disease, pneumonia. One of Dr. Ofri's patients is an older woman covered with skin ulcers. Another woman needs -- but probably won't get -- a heart transplant because of her status as an illegal immigrant.
Dr. Ofri tries to keep an ear tuned to the stories behind her patients' medical complaints. And she tries to spend as much time listening as she can, without getting too far behind schedule. Answers to questions about family or jobs may not help with a medical diagnosis, but patients want to talk, Dr. Ofri believes. Conversations like these can help gain a patient's trust, and they help the doctor, too, she says.
"One of my interns said, 'When a patient gets dressed to leave, they are so different. Once they are in clothes, they look so healthy. And when they are in Styrofoam slippers with those horrible gowns that fall open in the back, they look so sick,'" Dr. Ofri recalls. "And I think we forget to envision them outside the hospital, in a life, paying taxes, riding the subway, combing their hair. So to let patients talk about their life outside, they come to life more."
Listening to their stories keeps her patients with her long after she's left the hospital, Dr. Ofri says. At night, she recalls their conversations, and wonders what else she could do for them.
"It makes me curious about them," Dr. Ofri says, "so when I go back the next day, I'm more connected with them. And I think a connection has healing power. Most of the patients brighten when they talk about themselves and I think they actually feel better."
A good part of Dr. Ofri's day is also spent overseeing the work of new doctors. The days are filled with jargon and medical shorthand. But Dr. Ofri also tries to inject another kind of language into the training: poetry. She carves out five minutes or so each day to gather with her interns and read a poem. She calls it her "literary rounds."
"I ask them to humor me, and they're usually pretty good about it. But some hate it," she says.
But through these brief pauses in the day, she says she's giving her students a "chance to let the other part of their brain flower a little bit."
"We talk fast, we walk fast, we think fast, we write fast," says Dr. Ofri, "and I think poetry and literature are a chance to stop for a minute and take a breath. To think about the metaphor in a poem is to really stop and look beneath the surface and see what else lies there. I'm just hoping the experience of doing that is helpful, and also trains (my students) to listen more carefully and listen for the metaphor in what patients talk about."