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
