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Melissa Zhu Murphy

On Mother's Day 2007, as I was finishing my freshman year at Vanderbilt University, I joined my parents for a warm, happy reunion in an Italian restaurant, celebrating both the day and the completion of my first year of premedical studies.

My father was blissfully breathing in the steam wafting up from his ravioli in lobster cream sauce as my mother prepared to dig into an enormous plate of basil penne pasta with spicy meatballs.

I took a bite of crusty Italian bread and lifted a forkful of manicotti to my mouth, getting ready to describe how hard I'd had to study for my biology and chemistry finals. Then I realized that something was wrong.

Very wrong.



It was my fork. It had somehow twisted itself into a bizarre shape, like something out of a Salvador DalĂ­ painting.

That's weird, I said to myself, staring at the twisted tines and handle. I took a look at the pasta on my plate. It too was distorted. I looked up at my parents, at the waiter pouring our wine and at the rest of the restaurant. Everything was distorted--weirdly curved to one side, as though it were being sucked into an invisible vacuum cleaner somewhere off to my right.

I took out my contact lenses. Nothing changed.

Wow, I thought. I know I'm nearsighted, but this is way worse than that.

We left in a hurry. My parents drove me to a local eye hospital, where I was assigned to see a retinal specialist.

A middle-aged man, Dr. Essers greeted us politely and asked me to sit in the examining chair. Never had I felt such anxiety while hearing the familiar words: "Put your chin right here, please....Press your forehead up against the bar....That's right; now look at my ear."

Five minutes later, Dr. Essers whistled under his breath. "There it is," he said softly, his face just inches from mine. "Just a minute...."

Afterward, with the lights back on, he said somberly, "There's a blood clot on the back of your retina. It behaves similarly to macular degeneration, but it can be caused by trauma."

"Macular degeneration in a healthy twenty-year-old girl, occurring while eating Italian food?" I said, bewildered.

"Or it may be related to your myopia," he added. "Let's get a florescent test right away." He turned to the computer screen and started to put in the order.

"I'm sorry," he continued distractedly, tapping on the computer keys, "I'm afraid this means that you'll go blind within two weeks...."

"Blind in two weeks?" I blinked a few times, trying to make sure I hadn't misunderstood. Then I turned to my parents. Using my minimal medical knowledge, I tried to explain Dr. Essers' diagnosis to them while also struggling to make sense of it myself.

Quietly, my parents walked with me to the fluorescent-test room. They seemed even more nervous than I was.

The test results were reassuring, but also puzzling: the florescent tags were all concentrated inside blood vessels, which meant that my retina was not actively bleeding. So what was causing this bizarre visual distortion? And why had it happened?

Dr. Essers offered no further explanation. "We'll continue to monitor your condition," he said. "Come back in one month."

As we left, I felt my enthusiasm for medicine fading away, to be replaced by doubt and suspicion about physicians in general, and about Dr. Essers in particular. Driving home with my parents, I oscillated between worry and wild speculations about my condition.

The next day my parents took me to see Dr. Smith, a pleasant young ophthalmologist noted for his academic and surgical accomplishments.

After examining my eyes, he rolled his chair back a bit, looked at me and said, "Tell me about yourself, Melissa. How is school? What do you study?"

"Well," I began, "I'm a premed student. I just finished my freshman year. We had final exams the last two weeks. It was pretty stressful, and I studied really hard...."

As I continued describing the college year just past, Dr. Smith listened attentively, offering nothing beyond an occasional nod or "Uh-huh."

After about ten minutes, he said, "Well, from what I hear, I think you have a mild condition called central serous retinopathy. It's induced by stress, and although it's rare--it occurs in only one in 100,000 females--it's more common in young people like yourself."

He gave me a moment to take this in, then went and found a handout describing the condition in more detail. Grabbing a marker, he highlighted the prognosis: most patients recover spontaneously without intervention. Then he handed me the paper, smiled and patted my shoulder.

"Melissa, I think you're going to be okay," he said. "I'll see you in a month to follow up. In the meantime, try to relax, because stress is the main cause of your condition."

Heading home, I felt almost giddy. Dr. Smith had performed a medical miracle: after just ten minutes of listening, he'd transformed my diagnosis--and my future. I'd gone from fearing imminent blindness to looking forward to an almost certain recovery.

My heart overflowed with hope--and with renewed admiration for medicine and physicians.

Dr. Smith was right. Over the next two months, my vision gradually improved until it was completely normal once more.

Now, seven years later, I'm a resident physician in anesthesiology, caring for my own patients. Like all residents, I have a hectic schedule--but no matter how busy I get, I never forget my debt of gratitude to Dr. Smith.

He taught me that careful history-taking and clear, compassionate communication can mean the difference between a faulty diagnosis and an accurate one.

And he showed me the most important instruments in every doctor's toolkit: not fancy equipment, but an open mind, a pair of listening ears and the right words, carefully chosen.


About the author:

Melissa Zhu Murphy is currently an anesthesiology resident at Vanderbilt University Medical Center, in Nashville. She completed her medical degree at Texas Tech Paul L. Foster School of Medicine. "I first became interested in medical humanities while taking a narrative medicine class as an undergraduate at Vanderbilt University." This is her first story for Pulse.

Story editor:

Diane Guernsey

Comments   

# Annette May 2015-10-12 12:34
I am so impressed with this story. As a patient I can assure you that to have a physician really listen to the reality f what is occuring is just as important as dispensing medication , referrals or anything else you do. Thank you for sharing this experience.
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# Dianne 2015-10-05 16:57
Ah...a great story about the importance of listening generously. People will often help you to discover their diagnosis if you LISTEN.
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# Christy Thomas 2015-10-05 08:41
Thank you for giving us this story. I'm a retired clergy person and frequently saw the therapeutic effect of deep listening. We professionals often feel the need to speak too soon, dispensing our knowledge, but doing so without real wisdom. What a difference it makes to start with the skill of active listening!
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# Diane Greig RN, MSN 2015-10-04 12:59
What a contrast of listening approaches! And this last clinician is a fine example of a partnership with the patient as he asked questions to help in the assessment. Short powerful story, thank you.
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# Ron Banner MD 2015-10-04 11:01
Dear Melissa,

Great story, beautifully told, and moving. Glad that the ending of your story is a good one.

Your story should be required reading for all medical students, residents, and practitioners - with a discussion afterwards. THAT WOULD HELP CHANGE HEALTHCARE PRACTICE.
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# Martina 2015-10-03 23:05
This is a great story because the prognosis varies so greatly, from one diagnostic potential to the other. And because the physician Dr. Smith was willing to engage you in the willingness to believe in the more positive and perhaps more likely answer, and to ask for your cooperation in stress reduction. He could have been wrong, but in comparing what the two doctors listened to, and asked of you, it is quite amazing, how Dr. Smith engaged your hope and willingness to be patient as the time evolved. And they both said to come back in a month! I think maybe if blindness were the potential, it would be better to see you sooner... but this is a very vivid lesson in how to be a better physician! THANK YOU!
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# Margaret Fleming 2015-10-03 15:29
Amen. Just Amen!
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# Pris Campbell 2015-10-02 19:21
Thanks ffor sharing this meanungful story. It tells us yet again that doctors aren't gods and finding the one with both skill and compassion is essential
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# Paul 2015-10-02 19:00
Wonderful story since it has a happy ending. We all should be like Dr. Smith, he embodied what a physician should be.
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# Marita Grudzen 2015-10-02 18:32
Greetings, Dr Melissa Murphy,
Great writing...reall y enjoyed your article and felt it emotionally.

And thanks for"the lesson" in communication.
keep writing,

Marita
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# Larry Forbes 2015-10-02 22:41
I enjoyed reading your narrative, particularly the positive conclusion.
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