During a home visit, many barriers to communication can be overcome, Landau says. “Our residency program emphasizes accurate empathy and the physician-patient relationship. The home visit-narrative experience allows residents first to experience and then take some time to reflect on the patient’s story—the multiple factors that affect the patient outside the exam room. A patient who might first be viewed as ‘non-compliant’ or a ‘poor historian’ for one reason or another is transformed into an individual who is actually resilient and trying to cope with the most desperate of circumstances.” Sometimes the residents are struck by the poor housing conditions, noise, crowding, and even safety issues they see. By sharing the narratives, Landau says, “we reach a deeper understanding of our cognitive and affective reactions.”
The effect extends beyond the individual patient. Julia Jacobs, MD RES’12, who is now a hospitalist in Tennessee, saw a patient at the ACI. “I think about that day more than any one patient I saw in residency,” Jacobs says. “When I see anyone in the hospital now who has served time, I feel a deeper understanding. … I know my experience helps me serve that patient better.
The following pieces are reflections written by residents after home visits.
Marie wants to have the strength and ability to go read to kids. Or work with the elderly. Meaning. Because that would “allow me to get through everything else.”
By Megha Garg, MD RES’
I met the most remarkable woman today.
Marie has endured everything: sexual and physical abuse by her father, abandonment by her mother, chronic illness, unemployment. Her husband left decades ago. She had a glimmer of hope earlier in life when she started college, but the rest of life sidetracked her. Now, on her worst of days, she has to figure out how to stretch their food so that she and her two sons can eat one meal for the day. She prioritizes the rent for her Section 8 housing apartment so they don’t end up on the streets. It is a diminutive home for three adults, with a lawn full of cigarette butts, rickety stairs, thin walls, and mentally ill neighbors whose lives can be heard all the time through those thin walls. She is afraid of being alone, even for a moment. It causes her to have a panic attack. She relies on her sons to keep her company; they do not have jobs or contribute to the household chores. She often misses her doctors’ appointments because it takes time away from dealing with all the other problems she faces. Her life is insufferable.
“I don’t have any plans to hurt myself,” she said. “But I don’t feel like living like this anymore.”
Yet, she welcomed us into her home. She showed us her world and articulated so beautifully the details of her life, her anger and frustration at the unfair hand she’s been dealt. What struck me most were her expressions of forgiveness. “I didn’t deserve to be treated like that, but I get why he did it,” she said of her father. She was able to stand outside of herself and observe her world.
“I don’t expect to not have any problems,” she said. “But I think everyone should be able to have moments of peace.”
So, what does Marie want, amid all of these problems, more than anything else?
Not more money or more things. Not even a better apartment.