“Useless” (But Needed) — “A Doctor’s Constant Companion”

From time to time, I cross-post a piece from Pulse: Voices From the Heart of Medicine, an online magazine that uses stories and poems written by patients and health care professionals to talk honestly about giving and receiving medical care.

Pulse was launched by the Department of Family and Social Medicine at Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, New York, with help from colleagues and friends around the state and around the country. Pulse is free. To subscribe, Google “Subscribe to Pulse Magazine.”

On “Washing Feet”: As many of you no doubt know, diabetes damages blood vessels and nerves. As a result, diabetics often have problems with their feet. They are not always able to sense an injury to the foot, which means that what begins as a minor scrape can go unnoticed until the foot is badly infected. Compounding the problem, diabetes alters the immune system, making it more likely that a small infection will spread rapidly, leading to the death of skin and other tissue  — and ultimately to the amputation of toes, and the foot itself.

Below the poem and my comment, along with a comment from a Pulse reader noting that: “uselessness must be a doctor’s constant companion, but not all doctors are able to recognize and accept it.”  This is, I think, a powerful and important idea.

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Washing Feet

Robert Fawcett

Being thorough, I remove a holey sock
to view a diabetic man’s filthy feet.
I use the time to complete our talk
of what drove him to live on the street
as I wonder how any of this can help.

While he tells me more of his medical past,
I run warm water into a stainless bowl.
I immerse both his feet and begin to ask
myself what good it does for this poor soul
to allow himself to undergo this ablution.

Silently I sluice the water between his toes
and soap the crusty callous at his heel.
I marvel at his arch and notice how closely
it fits my palm. I know he can feel
this proximity too. He shuts his eyes.

Months of useless layers peel away,
revealing layers useless weeks ago.
Removing the tough brown hide of yesterday
yields clean pink skin, but we both know
this ritual will be useless days from now.

Still, this moment may withstand time’s test,
teaching us each lessons unknown before.
I learn the medicine of selflessness.
He learns what medicine is really for–
the hope that basin, soap and touch can bear.

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When I first read this poem, I was stopped by these three lines: “I marvel at his arch and notice how closely/it fits my palm. I know he can feel/ this proximity too. He shuts his eyes.” Then I read those lines again.  They capture the intimacy between patient and doctor.

The poet writes: This was an experience I had years ago that brought me an increased awareness of how important care is to medical care. Meeting patients on that personal, humanistic level pays huge dividends in terms of both our understanding of the patient’s disease state and the patient’s understanding of (and adherence to) our recommendations.”

One Pulse reader commented: “It is wonderful how this poem unfolds; the repetition of “uselessness’  . . .  heightens the message of the last lines. Uselessness must be a doctor’s constant companion but not all doctors are able to recognize and accept it and so perhaps never learn about other kinds of healing they can offer. In your case, the gift was not just what you did, a great gift indeed, but also the gift of providing something far beyond the scope of what was asked for, beyond what the patient could have conceived of, beyond your own expectations …”

7 thoughts on ““Useless” (But Needed) — “A Doctor’s Constant Companion”

  1. A lovely post, Maggie.
    I was two or three years into the cafeteria business before appreciating how much good service rested on uniformed employees getting paid simply to be available when needed, either at the serving line or in the dining room.
    Years ago in a fit of frugality (an occupational hazard in business models with tight margins) the bean counters contracted with a team of efficiency experts to study the operation to recommend ways to save expenses. They were aghast that so many people were being paid to “just stand around” so the best they could do was generate some numbers which the company later used to control hours to match “customer counts” (number of transactions).
    We called it EQF (Equivalent Full Time) and I later learned that FTE (Full Time Equivalent)numbers are supposedly derived the same way. But somewhere between theory and practice the focus slowly shifted from service to time clocks. The result was better profits but the price was paid in service. Good service took what bankers call a haircut.

  2. John–
    Thank you.
    I agree, and I think that while the bean-counters may be right about short-term profits, over the long term, investing in “service” pays off. Customers remain loyal.
    And if service matters in the food business, imagine how much it matters in healthcare where, I think, both patient and doctor benefit when they feel that
    intimacy.
    I have heard doctors complain about “fixing up”
    homeless people in an ER who are just going to go out on the street and drink again.
    I can understand why they might well feell that their work is pointless (“useless”), but my guess is that doctors who understand the value of the service that they are providing when they offer comfort (without any hope of cure) are much less likely to burn out.

  3. Many people don’t appreciate that in a number of ways, health professionals are artists. I enjoyed this artistic means of reminding readers of this reality.

  4. Matt wrote that “Many people don’t appreciate that in a number of ways, health professionals are artists”.
    ————–
    There is no way to adequately standardize art and artists. Therefore those areas of supposed healthcare where this statement is true cannot and should not be paid for by pooled resopurces, either socially pooled or through private insurance pools. Also, people must be informed where art is the major driver behind treatments rather than objective data and measurable procedures, IMHO!

  5. Matt– Thanks for your comment
    Ng– I think Matt is talking about the art of caring for people–comforting them, even when you cannot cure them.
    This is a invaluable part of what doctors and nurses do. You are right, it is impossible to measure the value of letting the patient feel recognized, known and cared for, but it is no less important.
    This is part of the “art” of palliative care. I recall Diane Meier talking about how just sitting with a dying person– simply being there, a quiet witness, can soothe the patient. One of the goals of medicine is to relieve suffering.

  6. The real work done is how to maintain the efficiency of a doctor regarding its practice.Many people don’t appreciate that in a number of ways, health professionals are artists. I enjoyed this artistic means of reminding readers of this reality.