A Smile

by Academy of Clinical Excellence on November 11, 2010

I had known him for a few months, when, for the first time, J greeted me with a smile. The persistent sad veil over his eyes had lifted. This simple facial expression changed my whole day.

J is from Central America and was hospitalized with what turned out to be disseminated tuberculosis affecting his lungs, liver, lymph system and gastrointestinal tract. At the same time, he was discovered to have advanced HIV and with a very low CD4 count and a viral load off the top of the scale. At discharge, it was arranged for him to have follow-up at the Baltimore City Health Department for his tuberculosis treatment which would entail directly observed therapy. The Health Department had contacted me to provide ongoing health care, especially related to his HIV diagnosis.

When I met J, he had finished about four weeks of tuberculosis treatment. He spoke no English and my medical school Spanish knowledge has definitely diminished over the years. We used a phone interpreter to help. I often felt a bit perplexed using the interpreter as J’s three minute responses sometimes became one sentence in English from the interpreter. J and I built rapport, but with the language barrier, it was not quite the same.
J had a family in Central America and was here working. He could not apply for medical assistance as he had no “papers”. We could provide him health care using our Ryan White Grant. Even with the grant, we needed to establish his residence in Baltimore City. On his second visit, he brought in a paper certifying that he “lives in Baltimore City with 3 amigos”. It was good enough for me.

Being treated for disseminated tuberculosis, J never felt well. It took several weeks, but slowly his fatigue and night sweats went away. He still weighed less than one hundred pounds. Four weeks into tuberculosis treatment, I initiated anti-retroviral treatment for his HIV. He developed immune reconstitution syndrome and felt terrible all over again. With a lot of encouragement and some prednisone, he finally was feeling better.
J had gained eight pounds since I last saw him and this was easy to see. I did not need an interpreter when he said happily, “Me siento muy bien.” We talked more and before leaving to have his blood drawn, he thanked me repeatedly and gave me a hug.

When I think about this patient now, I can still feel that hug and it reminds me that continued effort and encouragement can make all the difference for a patient and can help them to smile again.
Please share your thoughts/comments.
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6 Comments

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Comments

bradweesner January 4, 2012 at 9:36 pm

Hi Dr. Fingerhood, thanks for sharing this story, it's wonderful. I know firsthand the warm and caring style you bring to your bedside manner - somehow even more relaxed that we meet in your office. The amount of time you allow me, how available you are, your staff, and your smile and laughter are so appreciated by me. I feel lucky to have you as my doctor. Thank you.

Anthony Phan December 13, 2010 at 6:44 pm

Hi Doctor Fingerhood. My name is Anthony Phan. I was one of your students when I did my residency in Internal Medicine at JHB. Thank you for a great article and thank you for the time you took in teaching me about the art and science of medicine. You and all of my teachers at JHB are the heroes of medicine.

Kathleen Grieve December 13, 2010 at 3:57 pm

Reading this brought a smile to MY face. I spent 7 years caring for HIV+ and TB pts. in the MD State Correctional System. Thank you for giving this gentleman a reason to smile.

Michelle Price December 13, 2010 at 2:38 pm

A smile can make the difference in someone's life...so easily this universal language that can give a person the smallest glimpse of hope where they might not find it otherwise. A smile can prevent suicide, domestic violence, child abuse. So when you think you cannot make a difference in someone's life because it seems you have nothing monetary to give, just smile.

Defibrillators November 12, 2010 at 10:33 am

I am a surgeon and I found your post very interesting. I was really not aware of such information. I would like to some more information regarding Clinical Excellence on kidney surgery.

Roy Ziegelstein November 11, 2010 at 4:47 pm

A smile needs no interpretation. Neither do care and compassion.

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