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Poetry & Medicine – The Poetry

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Who Decides?

I didn’t expect it to be an easy conversation,
except that [name] has such an admirable presence
and a kind, spiritual manner.
 
Still, she is waiting for lungs,
while hospitalized for months already,
with no end in sight.
 
Talk about anxiety and how to deal;
when the patient has good reason to be anxious
and the doctor is anxious to please.
 
A good place to start is mindful listening,
but what was I hearing?
more anxiety, uncertainty and fear.
 
Her fear was of the medicine
and the loss of control it might cause
and even deeper, a fear of death.
 
Sure I was in the position to decide
but fears like those
even made me nervous.
 
There are so few things in life
that we actually have control of;
little decisions become very big, quickly.
 
I was sure the medicine would help the anxiety
but what would it do for fear
and the sense of uncertainty.
If I decided for her,
how would that affect
her need to feel in control.
 
Her feelings, my issues and
her needs, my wishes were
all jumbled together.
 
How should I consider
my responsibility to the patient
and my wish to help?
 
Amidst all the uncertainty and indecision,
all the anxiety and fear,
I decided.
 
I decided to ask her;
to decide for herself, if she could.
She could and did decide--no new medicine.
 
She had decided for control and less anxiety.
I had decided against control for less anxiety.
We made a shared decision.
 
And next time? What will happen?
Who will decide?
I hope we decide together.

 

ROBERT M. LAWRENCE, MD
Pediatrician who listens for poetry
in his patient’s (hi)story



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