In Lessons Blog

Samantha—or Sam, as she preferred to be called—was a young surfer recovering from a serious car accident. I first met Sam when I was a second-year resident at Stanford University, rotating through the orthopedic service. She was a 16-year-old surfer from Santa Cruz with a bit of an attitude—athletic, with a deep bronze tan and straw-colored hair bleached by the sun.

One night, as she drove her car up the winding road from the beach to her home in the hills, the vehicle careened off the road. She fractured a dozen bones in her arms, legs, back and pelvis.

Sam needed surgical repositioning for some of the fractures and traction for the bones that could not be safely put back into place. Traction involved inserting stainless steel pins through the broken bones, attaching the pins to a series of weights and pulleys, and keeping her on strict bed rest in the hospital for three weeks. Once the constant pull of the weights moved the bones into their original anatomical positions, we would apply a full body cast and send her home.

Rounds on a surgical service begin at 6:00 a.m. and need to be complete by 7:30 a.m., when surgery begins in the operating room. With 20 patients to see each morning, speed and efficiency are essential. Most of the time is devoted to the sickest patients. These are the ones who had surgery most recently, and those with complications such as pneumonia, wound infections or major bleeding. All others get a very brief visit.

After a week in the hospital, Sam was stable medically and surgically. As a result, our team of doctors rarely stayed with her longer than a minute or two on our morning rounds. Six or seven of us—attending physician, residents and medical students—would walk into her room in unison. We would stand halfway between the door and her bed. One of the students would read from the medical chart and report that Sam had no fever, update us on the most recent x-rays, and describe the current position of the bony fragments. The resident responsible would turn to her and say, “Everything is going great.” Then, as though we had choreographed the movement, we would turn as one and leave.

A Problem Beyond Broken Bones

After a week of these cursory daily rounds, Samantha surprised us. Just as we turned to leave, she said, “There’s moss growing under my leg cast.” This got our attention. We huddled around her bed, pulled back the sheets and began to fire questions at her. “When did you first notice it?” “Are you having any pain?” “Does it itch or burn?” As we peered closely under the cast, we could see that no moss was actually growing under her cast. Sam quickly admitted to having put it there.

She had asked her younger sister to go into the forest near their home and bring her a thatch of green moss. Earlier that morning, she had inserted the moss under the edge of her cast, her intention to teach us a lesson. “You stopped asking me how I was doing,” she said, “and what I was feeling. I didn’t know what else to do to get your attention.”

From that day forward, each of us doctors made certain we said good morning to every patient on our service and asked how they were doing. And even more importantly, I learned to inquire before I left the room, whether in the hospital or the office, if there was anything else they would like to tell me or anything I had forgotten to ask.

Those few extra minutes during which I listened intently to my patients have paid remarkable dividends. Dozens of times, I have diagnosed problems that I would have missed, and long before they would have become serious. And by listening to stories from hundreds more, I have learned a great deal about people and gained valuable life lessons. Although I cared for Sam many years ago, what she taught me remains as vivid today as ever.

 Dr. Robert Pearl is the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD
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