“Vulnerability is our most accurate measurement of courage.”
How much time does it take to gain another’s trust? I used to think that trust only came with multiple experiences over the course of years of interaction. As a result, I missed many opportunities with patients in the past 20 years of my medical practice. Is it possible that trust can develop within minutes of a new introduction? Is there any situation more vulnerable than a patient sharing personal issues to a complete stranger who happens to be a physician? As always, patients teach physicians more than physicians teach patients. A recent interaction allowed me to dispel my long held belief about the time it takes to gain trust. I opened my eyes, ears, and heart. The patient served as my instructor. The stage was set for a perfect life lesson.
Tammy described a life of trauma. As a child, she was routinely abandoned by her mother as her mother sought various male relationships. It got to the point that she and her siblings were raised by her maternal grandparents. She noted that her grandfather was “stern” but he had her maternal grandmother “discipline” the children. That often included physical means of punishment. As the oldest child, she took on the role of the protective mother to her brothers and sisters. She noted that her younger sister slept in a dresser drawer in her bedroom. Needless to say, she had a close bond with her siblings. However, she longed for a relationship with her mother. Unfortunately, her interaction with her mother was less than ideal. Trying to stay close to her mother only increased her trauma. Two of her mother’s male partners made sexual advances on her as well. Tammy was dying of metastatic lung cancer at the time of our meeting. Like all lives with serious trauma, Tammy was succumbing to the effects of her personal treatment plan. She had used smoking as a means to manage her stress. And, as the Adverse Childhood Experiences Study points out, at age 53, she was facing an early death from the consequences of her early childhood trauma. I asked her about her hopes to connect with her mom. She accepted the fact that her mother was incapable of reconciliation at that time. We talked about the fact that we only had control over our own perspective and choices. As painful as it was, Tammy’s mom lacked the insight necessary to mend the pain of a compromised relationship between a distant mother and a longing daughter. While there was little consolation, Tammy was glad that someone listened to her. She told me that she planned to enroll in hospice care. She expressed her appreciation of our time together because I did not “treat her like a number.” I had known her less than 15 minutes prior to her sharing this story. What was it about our interaction that allowed that depth of sharing? She cried openly and we hugged each other on my departure.
So here’s my dilemma. How many patients have a story to tell? Is the story always pertinent to the information that I need to direct his or her treatment plan? Given the time constraints confining our current healthcare system, how can I gain a person’s trust in order to even be welcomed into the story? Am I willing to give a part of myself freely to another human being? If another person fails to acknowledge or rejects my declaration of love, does that change my expression? Is the person willing to share an intimate story with a stranger? Tammy taught me that she would share if I would love. I need to be vulnerable in order to love. The patient needs to be vulnerable in order to trust. If I love first, trust follows quickly. At the base of our interaction is the willingness to be vulnerable together. My hope is that I have the emotional strength to be mindful of the importance of being vulnerable. Are you courageous enough to be vulnerable?