Watchful Ears are Listening

Lyle, Patricia

As a second year medical student at the Northern Ontario School of Medicine I enjoy the community rotations incorporated into our training. This past fall I was in a family practice located in a small rural town northwest of Ottawa. During this time I met numerous community members, partook in local events, and grew comfortable with my living accommodations and routine. I enjoyed the morning jaunt to work, passing the local convenience store and dentist’s office where the dentist, hygienist, and patient (whomever was in the chair at that time) would look up and wave as I walked past. The weather was not always sunny, but made for various pictures as I crossed the bridge overlooking the Ottawa River. On one crisp morning, looking out at steam rising from the cooling waters, I wondered what experiences the clinic would hold for me that day. My placement coming to a close; I had already learned so much, and strengthened many clinical skills in everything from suturing, fracture setting, and injections. This day would inevitably provide another learning experience, but little did I know just how valuable this one in particular would be.

The clinic was bustling that morning, and we flew in and out of rooms. Before entering the next room, the doctor scanned the chart and chuckled. ‘This should be fun,’ he announced and I followed him into the room. Sarah was a squirmy three year old, sitting restlessly on the examining table with her mother, just older than myself, anxiously awaiting. Sarah’s mother, Donna, had phoned the previous afternoon in a panic and the receptionist had squeezed her into our already booked morning. Despite our hectic schedule, the doctor sat down with Donna, looked her eye to eye, and invited her to start from the beginning. As far as he was concerned, he and Donna were the only two people in the room, and the clinic’s chaos was now miles away.

Sarah loved trying new things and was a very active three year old. She kept her mother busy and had developed the mischievous habit of hiding small objects, often using her nose, mouth, and ears as hiding places. Donna was usually pre-emptive and avoided leaving small objects lying around. On the previous day, Donna had given Sarah a new arts and crafts kit as a present for good behaviour. Sarah loved being creative and her Mother looked forward to having something to keep Sarah preoccupied while she could attend to other household duties. After leaving Sarah for a few minutes, Donna returned and noticed Sarah tugging on her right ear. Becoming suspicious, Donna attempted to count the kit’s components, but the scattered mess of bits and pieces made it an impossible task. Peering into her daughter’s ear Donna saw nothing but a trail of green sparkles leading into the dark canal. Thinking it best to get Sarah checked, even if it was just an ear infection starting, she phoned to get Sarah in as soon as possible. She was relieved to have gotten the appointment so quickly, and felt a bit silly but better to be overly cautious.

‘You certainly did the right thing,’ the doctor said. I watched in awe. Not only was he managing to applaud Donna’s parenting, but she seemed soothed by his soft, patient words. With one fluid motion he lifted the otoscope of the wall and before Sarah could react, he peered down her left ear canal followed by her right. ‘Ah Hah!’ he exclaimed and I anxiously took the otoscope from him. ‘Your turn, tell me what you see.’ As I took the otoscope I paused to ask Sarah what she thought I might find in her ears. I often employed this technique with younger children as a game, imagining carrots and potatoes from last night’s dinner, or the occasional blueberry pie. Nothing could have prepared me however, for what I would find. Sarah’s left ear canal was clear, no cerumen, a beautiful opaque tympanic membrane, nothing out of the ordinary. I continued to her right; anticipation building. I steadied the otoscope and reassured Sarah who began to look increasingly uneasy.

I was shocked. ‘Bet you weren’t expecting that, were you?’ the doctor blurted. I shook my head and looked again. Sarah sat very still with huge smile on her face. Lodged deep in the canal, with a few green sparkles, was a googly-eye staring back at me. Sarah giggled. A googly eye of all things? Part of a usual craft kit no doubt, but staring out from an auditory canal, made the situation comical. ‘You like crafts Sarah?’ I asked as she nodded. ‘I think she likes scaring her mother more, just check out that smile’ the doctor chuckled, ‘What do you think we should do now?’ he asked. I was on the spot while Donna looked on, horrified. ‘Umm.... ‘ I pretended to ponder but truly had no idea of the next step, ‘try flushing?’ ‘Perhaps’ he said, ‘but realistically, Sarah is in no immediate danger and it’s lodged pretty tightly. I don’t want to risk pushing it deeper. I think our best option is to refer her to a specialist. She should get in within a few days, they’re usually good with these types of things.’ His last comment gave me a sense of belonging; physicians collaborating and working toward the health of one patient. After reassuring Donna, we waved good bye to our little patient over her mother’s shoulder. Donna was so thankful despite now having to wait and travel to see the specialist.

Later on, I reflected on the day’s events. This was a story I would remember throughout my clinical experiences. There is always a ‘to do’ list. Distractions take away from the patient, the therapeutic relationship, and healthcare professionals’ ability to obtain information and form interpretations. Patients should feel reassured you are there for them 100%. We expect the same, don’t we? No one wants to talk to someone who’s not listening. I also learned the importance of teamwork to complete all aspects of a patient’s health. No one person knows everything; realize limitations, and seek to utilize unique strengths and knowledge of others.

The encounter reminded me that I’m a role model for patients, peers, everyone I encounter every day. We look around, follow norms, and without realizing, mimic others. Someone orders something and it influences our decision. Someone jaywalks and we decide to chance it too. Some decisions are good, others aren’t. We can all be positive role models. Sarah, like the googly eye, was watching me. Hopefully she would remember the encounter and pursue a healthcare career.

As a future physician I encourage those in the medical field to remember our influence on others: patients, colleagues, and community members. We all look for direction, ideas, and suggestions in our mentally fatiguing, time consuming society. Patients are watching us with their eyes and ears.

Theme: Patients | Patients
Theme: Physicians | Médecins
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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