Medicine Out of Context

AirplaneA Doctor Makes an Airport Connection

by Danielle Ofri
Los Angeles Times

I ducked into the ladies room at LaGuardia Airport for a quick pitstop before boarding my flight. I stepped toward the second row of stalls, but a housekeeper was washing the floors. As I backed away from the wet section, the Hispanic-looking housekeeper flashed me a broad smile. I assumed she didn’t speak English and was using her smile to warn me off the wet floors.

As I was washing my hands after I finished, I was thinking that had I pulled my brain together fast enough, I might have spoken to that housekeeper in Spanish, thanking her for preventing my slip on the floor.

The housekeeper was by the exit as I made my way out of the bathroom.  She stopped mopping and gave me that warm smile again. “Gracias,” I said, this gathering my language neurons.

Doctora,” she said, and I could see that she was waiting for a response. “Recuerdame?”

Suddenly I recognized her as one of my patients. Once I could envision Señora R. in my clinic, I knew exactly who she was.

“This is where I work,” she said in Spanish, gesturing around us. The pride was evident in her voice.

Como está?” I asked, astonished that I had been so influenced by the surrounding environment that I did not initially recognize my patient.

Doctora,” she said, “there’s actually something I’ve been wanting to ask about, but the next appointment for you is so far off.”

I gazed quickly at our surroundings—white tile walls, rows of sinks and stalls, scattered travelers washing their hands. But no one was near us at the moment so I relaxed the grip on my suitcase. “Do you want to tell me?” I asked quietly.

She pointed to the edge of her clavicle, right at the base of her neck. “I think this has been swelling. It feels larger than the bone on the other side.”

I squinted at her neck, but didn’t see anything amiss. She pointed at it with her finger. If I were in the clinic, I would have immediately reached out and touched what she was pointing out. But something felt odd, here in the restroom of LaGuardia airport. It was one thing to have her tell me her medical concern; the interchange of words seemed to fall within the confines of allowed conversation. But touching her, reaching across the physical divide, felt as though we were breeching a barrier.

But Señora R. continued to point to her clavicle, inviting me to examine it. I looked around again; we still had a modicum of privacy. My mind ran over the factors: The area of her body in question was readily accessible, no clothing would have to be disturbed. This problem was clearly bothersome to her. I was heading out of town and wouldn’t be back in clinic for another week.

So I reached out my hand and palpated her clavicles. I could sense her body relaxing as I touched her, as though the very act of physical exam was itself somehow reassuring. The right side was maybe a touch larger than the left, but I didn’t feel anything terribly amiss.

I asked her a few more questions—recent trauma, fever, weight loss, chills, swollen lymph nodes. She shook her head no to all of them. “I don’t think it’s anything,” I said. “It’s probably the natural asymmetry of the body, and maybe you’ve only noticed it now.”

She looked unconvinced. My flight was boarding in fifteen minutes. “Listen,” I finally said. “I’ll be back at the clinic next Wednesday. Call me or drop by, and we can talk about it some more. If it’s really bothersome, we can consider an X-ray.”

She thanked me heartily, and, as so many of my patients did at the end of a visit, extending blessings to my children. She also wished me safe travels.

I dashed through the terminal and arrived at the departure gate just as the flight was boarding. As I crammed my bag in the overhead compartment, I reflected on this tiny medical interaction in the LaGuardia airport ladies’ room.

Even in non-medical settings, the doctor-patient relationship still retains potency. I’d felt a little awkward conducting medical business out of context, but Señora R did not seem to. Access to care is a challenge, and an opportunity for health care apparently wasn’t something to be squandered.

But I also found my heart inexplicably warmed. Something about seeing a familiar face, having a personal connection, made the gray anonymity of the airport seem less sterile.

I was honored by Señora R’s respect and trust. She reminded me why I would choose medicine over an office job any day. She also reminded me that a human encounter—of any type, in any setting—is what keeps us connected in the world.

(from theLos Angeles Times)