Student Perspectives With a High-Utilizing Patient

It could have been any time, on any day, in any doctor’s waiting room, but today was different. Today, I was sitting with Mrs Murphy and she was scared. She insisted we call her Paula. She stopped smoking a month ago, but she was nervous and the undeniable smell of Parliaments wafted from her clothes while we waited. The analog clock on the wall ticked to 2:27 pm.

We were waiting for a 2:30 pm appointment to see Dr Green. He was the first doctor that Paula told us about when we met. It was a steamy day in the summer 4 months ago when we met in her apartment on the south side of the town. She told us that he was handsome when they met during his intern year. So young, and smart, and nice to talk to, she explained. He listens to her and she trusts him. Dr Green was running behind today.

We are working with Paula because we are a team of health professional students selected to participate in a grant project focused on identifying “super utilizers” of our health-care system. We met Paula because she is in fact one of these “super utilizers.” We are a team of students from medicine, occupational therapy, pharmacy, couples therapy, and nursing. Our time with Paula is almost done, we have been working with her for nearly 5 months, and she will be graduating soon, at which point she will transition back to the care of her primary health-care team. Today, Mariana, a medical student, and I, a nurse practitioner student, sat with Terry, a caseworker, and Paula to see Dr Green.

The clock crept to 2:35 pm. We needed to make plans for Paula’s graduation. We had a date, time, and location, but we still needed a guest list. This seemed like as good of a time as any to hammer out these details. Who would come to celebrate Paula’s graduation? She hadn’t graduated from anything before. High school wasn’t for her, but she plans to get her GED (High School equivalence exam) one day. The last 4 months have shown Paula that she can accomplish her plans, if she puts her mind to it. We know her whole story or as much as she wanted to tell us. We know about the incest, trauma, abuse, neglect, and her spirit to live in spite of it all. She shared all of this with us.

Her palms were sweating and her speech was only slightly above a whisper. It was 2:43 pm and now we knew she wanted to tell us something important. Paula has a way about her. People want to help her and she knows this. She missed an appointment with us last week and worried we would be mad. She was sorry and wanted to tell us why she missed it.

It was a long day of visiting her ailing cousin 2 weeks ago, when the driver of her assistive transport service offered to walk her up to her apartment and proceeded to force himself on her, twice. She knew he was wrong but wanted to handle it her way. No police. No report. Nobody needed to know, not even Dr Green. She changed her phone number and told security to not allow him in the neighborhood anymore. That was that.

Mariana and I sat, stunned, 2:46 pm.

I am a nurse. She is about to be a doctor. We are helpers and healers and caregivers. It isn’t in our nature to sit stunned and speechless. We have loved and cared and provided support for this woman who now sat in front of us unprotected, raw, hurt, and broken. There were no words or gestures we could provide that would heal this hurt. So we sat. We held space for her. We listened as she told us what she wanted to us to hear. We thanked her for sharing, and we agreed not to share her story. It was her story after all, not ours.

The clock jolted to 2:50 pm and Dr Green approached us. We walked to a patient room. The news felt like a 100-pound weight around my neck. How could we sit in this room, hot and thick with tension and not tell him? We sat down. He asked what was going on. How had things been going? Was there anything Paula wanted to talk about? She hemmed and hawed. She mentioned her medications and asked questions. “Was there anything else,” he asked. “I was raped,” she said. “Oh?” he asked. “My driver. He won’t do it again.” “Do you want to talk about it?” “No, not really.” “Okay.” He would like her to follow-up with Dr Schwartz, her psychiatrist. She agreed to call him.

We left the room and walked by the clock again, 3:07 pm. Our team needed to debrief. What could we possibly know about dealing with this sort of trauma? We needed to talk about what happened. Mariana and I sat and reflected. The team listened and we all hurt together. We leaned on each other and received the council of our advisors and faculty. We acknowledged the support we needed for hearing the trauma of this woman. It wasn’t our trauma but it felt like it was. The team needed to rely on each other.

Graduation happened a week later. We thanked Paula for her time, her vulnerability, and her willingness to not only participate but to engage fully with our group of students. We hugged her and reminded her about the tools and the skills she had learned over the last four and a half months, and then we said good-bye.

Saying good-bye to Paula didn’t mean forgetting or letting go of the lessons learned. The ability to hold space for people, to treat them like humans, and to give them the respect and time they need to heal is not included in the nursing school curriculum I experienced. Compassion, empathy, and love aren’t required to pass your boards, but they are certainly necessary in the giving of care to people.