Along with penicillin and morphine, asking and listening are among the most essential tools in our medicine cabinets
On the very first day of our very first clinical year, I met a patient who would fundamentally challenge my perception of clinical medicine, a Māori man named Ereuti*.
I first met Ereuti on the ward round. The medical team bowled into 14B*, with the sunlight streaming into that whitewashed room. Ereuti was a gaunt, pale man with sunken eyes in a hospital gown, sprouting various lines leading to various whirring devices. He asked whether he could go home. The oncologist was sympathetic but didn’t mince his words. He could, but without the constant intravenous infusion, he would be making the choice to go home to die. Ereuti looked at his hands and said nothing.
The ward round continued as if everything were normal. I felt anything but. My mind kept drifting back to Ereuti sitting alone in that room having to grapple with matters of life and death. Was ‘popping in’ to deliver such news, between attending to the patients in 14A and 14C, all in a day’s work?
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Later that day, I was asked to take a medical history from Ereuti. Intuition spurred me to ask him what mattered most to him now. He replied, “What matters is regaining health, eating without this tube in my throat and moving my bowels naturally. Relationships. Relationships where I can be myself. Relationships like the one we’re building.”
At medical school, actors with whom we had practised might have responded to such a question with “getting rid of this knee pain” or “returning to work”, and reassurance was easy to give. But I had no words for Ereuti’s answer, which felt as though it drilled down to the very essence of what it meant to be human.
I felt strangely uplifted by what he'd said, struck by his clear sense of priorities, and moved by his yearning for dignity and the certainty in his voice. I sensed he’d been waiting for the opportunity to express his deepest desires.
Over the next few days, I asked myself the same question I had asked Ereuti. He wished simply for a healthy body and meaningful relationships. Meanwhile, the value I placed on academic and career pursuits, often at the expense of spending time with family and friends, seemed short-sighted. As confronting and refreshing as it was, I couldn’t help but question my values, and what matters most.
We’d all heard the adage that one learns from one’s patients. As doctors we serve, but we have an even greater privilege to be privy to the innermost lives and thoughts of our patients. The doctor-patient relationship is one of reciprocity. The insight and wisdom we gain, and perhaps take for granted, is humbling.
Sometimes I worried that the extra time I spent with Ereuti compared with other patients might be unjust. I was reassured by a mentor who said inequity of input is often required to achieve equity of outcomes – put simply, some patients need more time than others. What looks like privileging one person may actually be an act of justice, a levelling of the playing field.
When I reflect on our initial conversation, I realise it was the first time I had seen Ereuti, and the first time I had allowed him to see me. It wasn’t until I sat with Ereuti one-on-one, sunlight still streaming into that whitewashed room, that I felt we truly saw each other as people for the first time – Ereuti and Thomas.
I let myself be seen beyond the student doctor with a shiny stethoscope and ironed shirt. And I could glimpse Ereuti’s life beyond being a patient in a hospital gown. A brother. A son who would be outlived by his mother. A storyteller. A father to a son my own age.
Until then, I’d thought that upholding the integrity of the student-patient relationship meant maintaining a certain distance. I now realise that, despite the professional context, the student-patient relationship is just that – a relationship – and relationships are most healthy when both parties feel comfortable revealing their true selves, and at times being vulnerable, all as part of establishing the connection that is so fundamental to the art of medicine.
The Māori concept of whakawhanaungatanga is often defined as the process of establishing relationships or relating well to others, but its literal translation is more akin to ‘the act of making family’. That means taking time to engage in kōrero to identify the shared connections that bind us. The student-patient relationship is no exception.
Over the following few weeks, I enjoyed popping in to see Ereuti. I felt the warmth of his smile as he recognised my increasingly familiar face, and I hope he felt mine. Our time together might have been spent sharing some medical knowledge, attending to his comfort, or talking about our shared aspirations: that the bowl of grapefruit sitting on the windowsill would ripen, that Ereuti would return to his tūrangawaewae, that there would be health equity in Aotearoa New Zealand.
Sometimes I worried that the extra time I spent with Ereuti compared with other patients might be unjust. I was reassured by a mentor who said inequity of input is often required to achieve equity of outcomes – put simply, some patients need more time than others. What looks like privileging one person may actually be an act of justice, a levelling of the playing field.
Ereuti remained in hospital when my oncology placement ended. Imagine my surprise when a few weeks later, I came across Ereuti sitting up with a big smile dressed in his own clothes, waiting to be discharged. He was eating soft foods and his bowels were moving once again. He showed me a photo of one of his mokopuna whom he was off to see. As we parted for what I thought would be the last time, Ereuti joked I could find him catching ‘kingi’ off the wharf near his home.
Some months later the palliative care doctor told me Ereuti was back, and that I might want to visit him because this would probably be his last time in hospital.
The gravity of those words hadn’t quite sunk in as I made for Ereuti’s room. He had returned, but he was gaunt and his eyes sunken once more. A wave of shock then indignation, then finally profound sadness washed over me. Between laboured breaths he managed, “I’m at peace with dying … It’s good to see you again … I’m at peace”.
A part of me longed to sit with him again, to hear any final existential musings the ‘master’ may have for his ‘apprentice’. But the space we once shared had changed. Ereuti had embarked on the final chapter of his unexpected journey. Holding back tears, I said goodbye and we exchanged smiles for the final time.
Despite being almost three years since we first met, memories of Ereuti still punctuate my thoughts. He continues to help me make meaning of the world, both within and outside the hospital. I feel privileged to have learned so early in my career that the practice of medicine lies as much in sharing our common humanity as it does in prescribing and intervening.
Along with penicillin and morphine, asking and listening are among the most essential tools in our medicine cabinets. Sometimes, a simple smile is top-shelf medicine.
When I set out on the very first day of our very first clinical year, I thought medicine was about diagnosing and treating disease. As I embark on my own unexpected journey, I know I have many technical skills to learn. But Ereuti showed me that sometimes it is the humanity we all possess that is the most powerful medicine.
* Name and details changed to maintain anonymity
This piece was edited from an essay on the student-patient relationship which won the International Balint Federation Ascona Prize.
