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Janani Krishnaswami


I first met you in pre-op. It was my first week as a third-year medical student; my white coat was still white, the hidden interior pockets empty and the ten gel pens neatly tucked in my front pocket still leak-free. Stationed on a surgery rotation, I had officially spent twelve hours in the operating room--a frantic, exhausting blur of standing on tiptoe, gripping surgical retractors and struggling to avoid contaminating the sterile operating field where the surgeons neatly clipped and cut. You were the next case. From your chart I knew the barest facts: your name was Marie; you were forty-five years old, diagnosed with invasive breast cancer and scheduled for surgical removal of both cancer-ridden breasts

As I made my way to meet you, my supervising resident tapped me on the shoulder. "Just to let you know," he said, "you probably won't get much of a history. She only speaks French."

Somewhere among my overworked brain cells lurked a few years' worth of grade-school French, so I shook your hand and launched into what I hoped was a confident introduction. "Bonjour, Marie! Je suis étudiant en medicine." Your eyes lit up, perhaps in recognition of a familiar language, or perhaps in amusement at my rusty français--in which I had just referred to myself as a male medical student. Though I could only manage two tenses, we "talked" for the entire hour before your procedure. You were a nurse from Guyana, I learned; a relief organization had covered your travel and medical care. You were nervous--"un peu" (a little), you admitted--but also hopeful, ready for what lay ahead.

We spoke but a few complete sentences to each other, yet our conversation left me genuinely invested in your care. I found my sore, sleep-deprived self recharged with enthusiasm as I retracted the muscles in your chest, mentally goaded the surgeons to peel away every cell of cancer, probed your lymph nodes and sutured and cleaned up the surgical wound. As you woke up, I bent down and told you, "Marie, c'est fini! C'est tout fini!" (It's finished!)

You were discharged the next day to your host's home. A few weeks later, I took advantage of a day off and phoned up, asking if I might pay a visit. I found you recovering in good spirits; in halting French and English, we talked more about your life in Guyana. I learned further details about the Guyanese refugee program that had constructed the medical and nursing school you had attended--and enabled your care in the U.S. Witnessing this philanthropy in action, I suddenly felt overcome by a sense of déjà vu, the resurfacing of a familiar ideal that had compelled me to become a doctor. It was, quite simply, the promise of making a difference.

You're back in Guyana now, but we've met again this year. Once, you were an Arabic grandmother I encountered in a community free clinic, gripped by fear that you had cancer. You didn't understand my English and I spoke no Arabic. I just held your hand and mouthed "We'll take care of you" over and over; finally you broke into a smile and said in thick, halting English: "I come bring you muhallabiah" (a sweet rice pudding). "You will like." Another time, you were the "far gone" patient on the psychiatry ward: a middle-aged woman with a history of substance abuse, bipolar disorder and schizophrenia, who ate only cornflakes and Diet Coke, wandered the locked halls with a guitar and launched into diatribes against doctors, lawyers and men in general. You gazed blankly at me and called me "Sarah," but accepted my gifts of extra cereal boxes (even Cheerios!) with regal grace.

I think of you now as my most important patient. You see, even as the grueling, mundane tasks of residency sometimes strain my idealism, your story renews my commitment to medicine--and that trite but honest goal, making a difference. This goal is reachable, I believe, through adept communication and its healing economies of scale. On an individual level, a doctor's clear and caring message to a patient engenders trust, assuages fears and hastens recovery. Within institutions, physician activism promotes awareness and fosters policy change. In the broader society, education and mentorship through literature, media and government initiatives can bring about real transformation, inspiring the apathetic student or potential drifter to rise as a leader in medicine and beyond.

Marie, I want to thank you. After all, you showed me that the best medium for medicine's healing potential is the language of the heart, and that sometimes the deepest communication and understanding between patient and doctor can come without words.


About the author:

Janani Krishnaswami MD graduated last year from University of Michigan Medical School and is currently a resident in a joint internal medicine/preventive medicine program at Kaiser Permanente and University of California, San Francisco. While at Michigan she was a regular contributor to Dose of Reality, a website about the medical school experience, and she is working on publishing a short story on cultural and socioeconomic aspects of medicine in India. Janani grapples with the mysterious, sometimes seemingly random process of learning medicine on her blog Help! I'm a Doctor.

Story editor:

Diane Guernsey