The Conversation Before the Jump

 

                                                           

Wart-for-conversation-before-the-jump-jpeghen he was my age, my dad talked someone off of a ledge.

Even though he has been practicing psychiatry since moving to America fresh out of medical school in the 1970s, I have a hard time imagining this moment. He was quiet, with his characteristic sleepy eyes, and stood out with a thick Indian accent and a huge head of curly hair.

Still, even when he didn’t quite fit in, my dad talked someone off a ledge.

The patient was in the locked psychiatric unit my dad was rounding on in Brooklyn, NY. No one saw this man stack three chairs to the height of a closed-off balcony. No one saw him wrest off the leg of a chair to warp the wiring that blocked access to that balcony or widen it into a hole that fit his body. And finally, when the patient returned to his carefully planned exit, no one saw him climb the wiring, propel himself through the hole, or stand on the balcony, five floors high, ready to drop to the pavement below.

But they heard him.

They all heard the patient scream—residents, nurses, attendings—and they all looked up. His toes had crept over the balcony railing. They spoke to him urgently. Another physician promised that if he came down, they would release him from the inpatient unit. It was a lie, but it was a strategy. The patient hadn’t budged.

My dad was silent at first.

This doesn’t surprise me. My dad isn’t the first one to talk at parties. My mom gabs away while my dad stays silent and listens. He often finds the quietest person at the party and elicits stories from him or her that no one else has ever heard. Later, he will tell my family details about that person that we cannot fathom. Not gossip, but something that lets us see that person more clearly. Like pulling aside a shade.

When I was younger, I would rant about annoyances as my dad drove me to school. Who would I take to the prom? Why did I have so much homework? Why couldn’t I lose weight? My dad mostly stayed silent. Sometimes he said nothing at all. His silence maddened me.

This quiet listening saved the man on the ledge that day, because my dad heard the words after the screams. The man was worried he would be stuck forever on the inpatient unit and wouldn’t be able to care for his children, get a job, or support his family. He thought the only way out was suicide. My father listened silently as he listened to me on the early morning drives to school. Then, carefully, he spoke.

He asked the man—a patient he had never seen before, and would never see again—whether he thought killing himself would help him provide for his kids. They talked about the man’s goals and how he might achieve them. The man thought about it.

Then he suddenly turned around, climbed back through the hole, and clambered back to the unit.

The conversation had saved his life.

I asked my dad how he knew what to do. Had he already been trained well enough in psychiatry to know what to do in such a charged situation?

He told me he had been reading a book at the time on empathy in communication, and that he drew on those strategies to connect with the patient. “It was worth a try,” he said.  

In medicine, we employ devices, drugs and procedures to save lives. We are in an era where we assess the cost-effectiveness of each measure and try to maximize efficiency. But can we put a price on effective listening and communication? It seems to be the key to all interventions. It seems like something that is most efficient when it’s not rushed.

I think of the good luck of that patient to encounter a physician who had studied empathetic communication, which is both a skill and an art. Too often, as a medical student, I hear physicians disparage the “fluffy” or “futile” role of psychiatrists. It baffles me. My psychiatrist father uses validated tools of medications and therapy to treat patients while also drawing on creativity and ingenuity in conversation. When I learned Chinese and taught my father some phrases, he used them to connect with a Chinese patient who was refusing life-saving surgery. After she listened to two sentences of my dad’s embarrassing Chinese, she felt less threatened and changed her mind. When he heard from an elderly patient about his granddaughter who was “going through ongoing financial trouble,” he investigated and got him out of a scam that would have wiped out his life savings. The stories go on and on, and the complexity of these conversations is both intimidating and fascinating.

This is why I chose medicine after dabbling in careers in journalism and teaching. While medicine is not always presented as a field that values creativity or knowledge of the humanities, the best doctors seem to be those who can innovate in the ways they connect with patients. The spark of innovation often comes from outside of medicine—from literature, traveling, and personal loss. My father’s father died suddenly when he was a toddler and I wonder if it’s part of why he is so good at staying unruffled in difficult circumstances.

Last year, I saw my first psychiatric patient as a first-year medical student. When I came face-to-face with a man whose partner placed him in an inpatient facility against his will, it was hard to know what to say, my mind suffocated by random self-disparaging thoughts. I’m a young Indian girl and he’s an older white man. I have a tremor in my voice and he’s speaking bombastically. I’m sweating and he seems to be having the time of his life. How can I connect?

I thought of my dad with his accent in Brooklyn and how he still connected with patients. So I asked what I thought my dad would ask: What is the most important thing in your life right now?

The patient started talking a mile a minute, words tumbling into each other without a break. I listened closely, as if nestled within his words, knowing that in those words, I might find the key to saving his life.

Vidya Viswanathan is a second-year medical student at Penn Med, and the founder and president of Doctors Who Create, an organization promoting a culture of creativity in medicine.

Vidya Viswanathan, MS-II