A medical student muses on humility, the art of medicine, and the importance of eye contact

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There, in the fluorescent-lit cafeteria of the Salvation Army, I felt mildly nervous, but I smiled nonetheless. This is part of the life of a medical student, projecting confidence despite a lack thereof.

By the time we visited the Salvation Army Harbor Light Center in Pittsburgh’s North Side, we had already seen several other facilities—many of them better funded and equipped than this one.  However, we had yet to sit down one-on-one with a client.

I took a deep breath and walked over to the first guy I saw.  Let’s call him Jim.

I asked him to tell me his story.  Open-ended questions are best, right?

Alas, he responded, “I thought you were going to be a bit more specific than that.”

So I started by asking about his family.  From there, we easily jumped from one topic to another.

He became addicted to several substances during his teen years.  It started at the end of high school.  He had a sports scholarship and was a stellar student, but he had a tendency to mouth off at teachers.  One of those teachers held a grudge and failed him in the last class he needed to graduate.  He had no idea until graduation day that he wouldn’t receive his diploma.  Mortified, he left his small town for the military instead of for college, and there, he abused substances because he couldn’t deal with the shame of disappointing people’s expectations for him.

Jim had been in and out of almost every type of treatment facility available. He critiqued some of the programs and mentioned that court mandated treatment hadn’t helped him. However, he knows it is sometimes just what others need.”  He’s an old hat at treatment, but he’s never been clean for more than a year.  He feels his current program is overly simplistic, but he is ready to engage fully with it this time.  Here of his own volition, he is doing all that he can to participate well.

Finally, I asked what we, as future physicians, can do better to help addicts.  He looked at me long and hard.

“I can see that you have a deep desire to be the helper, the caretaker,” he said.  “Do that.”

He went on to say that if I show that I actually care about my patients, if I look them in the eye and see them as human, I will more often be able to intuit whether someone is drug-seeking or whether they are abusing substances.

He thanked me for listening to him and sent me on my way.

Jim taught me many things that day, more than most of the classes at my medical school or in the rest of the Scaife program.  No doubt, there is extensive value in learning statistics about drug use, pharmacology, neurobiology, and social determinants of addiction.

But the most valuable part of this program, for me, was about the intangibles.

It was about holding Jim’s intense gaze for an hour as he told me his story and wanting to hear more at the end of it.  It was about approaching an issue I knew little about with real humility and learning from those who have experienced it.  It was about learning the art of medicine in addition to the science of it.

I imagine that most of us won’t feel that we’ve mastered the intangibles of medical practice until many years after residency.  Thus, this was a beautiful opportunity of which I am honored to have been a part.

shannonShannon Adele Looney is a second-year medical student at the Medical University of South Carolina.  In July, she participated in IRETA’s Scaife Medical Student Fellowship, a three week intensive learning experience about addiction and its treatment hosted by IRETA since 1999.