What the Doctor Said

(by Raymond Carver)

He said it doesn't look good

he said it looks bad in fact real bad

he said I counted thirty-two of them on one lung before

I quit counting them

I said I'm glad I wouldn't want to know

about any more being there than that

he said are you a religious man do you kneel down

in forest groves and let yourself ask for help

when you come to a waterfall

mist blowing against your face and arms

do you stop and ask for understanding at those moments

I said not yet but I intend to start today

he said I'm real sorry he said

I wish I had some other kind of news to give you

I said Amen and he said something else

I didn't catch and not knowing what else to do

and not wanting him to have to repeat it

and me to have to fully digest it

I just looked at him

for a minute and he looked back it was then

I jumped up and shook hands with this man who'd just given me

Something no one else on earth had ever given me

I may have even thanked him habit being so strong

 

"What the Doctor Said" by Raymond Carver, from All of Us: Collected Poems. © Harvill Press, 1996. (Wonderful audio rendering of the poem)

 

Guiding discussion:

1. Although it is not specified, this poem could represent a typical patient/doctor encounter in an emergency department or acute care setting. How can the connection between doctors and patients be enhanced or sabotaged by expectations?
2. Can true connections result from planned encounters? Is there more value or validity to the unplanned and unpredictable?
3. Has there been a situation or a case in your own experience where a sudden or unexpected connection was made with a patient?  
4. Can you describe situations when you thought you had connected with a patient or family and it went awry? In retrospect, can you identify what happened?
5. Have you had difficulty conversations with patients that went surprisingly well? Were you comfortable with that unexpected response? Do you think they understood what you were saying? Do you feel they were in denial?
6. Giving bad news is taught in most medical schools and residencies. In what ways do you feel these tools are helpful? Limiting? Do you feel it allows you to have an authentic dialogue, or do you feel it’s constricting, making you feel that you must follow a script.

 

Exercise:

1. Stereotypes can often blind us to making connections. List out some stereotypes that patients believe about doctors. Do you find validity to them? Can you determine the source of these stereotypes that they are perpetuated? Do you find yourself falling into practice patterns to perpetuate these?
2. Can you describe a situation when making a connection with a patient or family was difficult, and write about it from their perspective, as a first person narrative, using “I”. Does it change your response to the situation, and perhaps how you’d approach such situations  in the future?

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