Peeking Behind the Curtain

“They’re anti-vaxxers – they won’t listen.” My resident whispered to me as we finally walked away from Johnny, the 6-month-old baby boy in Room 9, one hour and some odd minutes later.^1,2 His tone is heavy, laden with implicit meaning. The pediatric hallway mural flashes by as we walk, a jewel-toned jungle depicting grinning monkeys gamboling amidst a wash of bright emerald-green leaves.

After several formative interactions with the family, a palpable sense of dread began to accompany our daily prerounds. My resident and I struggled daily to convince them to allow basic blood draws; we failed utterly on the topic of flu shots. 

My resident, usually composed, started displaying a series of nervous tics, from pausing outside the door to breathing deeply just before knocking. Eventually, we resort to maintaining an exit pathway to the door, as if to subconsciously escape the daily question bombardment on our clinical judgment and the veracity of scientific rationale, all delivered in an aggressive tone by the parents and fueled by anti-science skepticism. By the third morning, I found myself too exhaling in relief by the time we exited Room 9. 

The fourth morning, an attending who favored bedside rounds joined our team. Huddled en masse outside Johnny’s room, I was stunned to see how calmly and patiently my attending fielded the family’s questions, modeling compassionate patient-centered care for the entire team and serving as an important reminder to us all. 

Like Dr. Paul Kalanithi once wrote in his gripping memoir When Breath Becomes Air, “The easy human connections he formed, the trust he instilled in his patients, were an inspiration to me.”³ I felt ashamed, realizing I had allowed anxiety to cloud my normal interactions. Antivaxxers or not, the family in Room 9 deserved care to the best of my ability. I returned to Johnny’s room that same day, resolved on immediately changing my attitude. 

When Johnny’s family initially responded to my discourse invitation with closed-body language, I was frank yet sincere, “I want you to know I am here to listen with an open mind. I would deeply appreciate the chance to hear your feelings.”  

As if suddenly unfettered, they spilled their fears out to me. I left the room hours later, humbled with my heart in my mouth. I realized what we had formerly written off as an aggressive tone was a tone of utter terror; the anti-science skepticism in Room 9 was actually a first-time mother and father’s panic over their acutely sick child and an understandable distrust of a confusing medical system.

In his Harvard Business Review article on eroding trust in U.S. health care, Dr. Richard S. Isaacs aptly notes, “Every [patient] encounter… is an opportunity to build trust,” a countermove to the deepening credibility crisis in the medical system, especially prevalent in conservative spaces.^4-6 Our initial mistake was attempting to convince Johnny’s parents about scientific evidence, thus creating a patient-provider impasse, rather than first empathizing with their concerns.

The day Johnny took a turn for the worse, my team advised urgent placement of a central venous catheter under anesthesia during attending rounds. Johnny’s parents balked, immediately wary of the potential harms of unknown chemicals and an invasive procedure on their precious baby. 

Afterwards, I stopped by to check in gently. “What are your concerns?” I remember asking them as I stroked Johnny’s hair soothingly. As Dr. Kalanithi aptly described, those moments in Room 9 became “an opportunity to forge a covenant with a suffering compatriot: here we are together, and here are the ways through – I promised to guide you, as best as I can, to the other side.”³

By the time evening rolled around, I emerged from Room 9, hopeful. 

The next morning, Johnny’s parents consented to the central venous catheter placement, provided I accompanied their baby boy every step of the way. I promised to stay with him, asked permission from my chief, donned an OR bonnet for the first time in my life, and wheeled Johnny out from Room 9. Later, in the same bonnet, I brought Johnny back to his tearful parents.

In the operating room, the blue curtain behind which anesthesia often sits is a common sight. But in the world of patient care, that curtain can exist unseen. It is essential to remember to peek behind that curtain in each of our Room 9s, see our patients behind a stereotype or impression, and take the time to listen rather than explain. It is our role as providers to make every single one of our patients feel heard.

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Melodyanne Cheng, MS, is a fourth-year MD/MBA candidate at UCLA David Geffen School of Medicine. Originally from San Diego, CA, they are focused on improving surgical health disparities, redesigning more equitable health care delivery systems, and impacting patient care from bench to bedside.

Notes and References

1. Johnny is a fictional pseudonym to maintain patient privacy.
2. The room number and Johnny’s exact age are both modified/fictional to maintain patient privacy.
3. Kalanithi, Paul. When Breath Becomes Air. Random House, 2016. 
4. Isaacs, Richard S. “5 Steps to Restore Trust in U.S. Health Care.” Harvard Business Review, 8 Sep. 2022, https://hbr.org/2022/09/5-steps-to-restore-trust-in-u-s-health-care.
5. Boyle, Patrick. “Why Do People Believe Medical Misinformation?” AAMC, 3 Nov. 2022, www.aamc.org/news/why-do-people-believe-medical-misinformation. 
6. Boyle, Patrick. “Why do so many Americans distrust science?” AAMC, 4 May 2022, https://www.aamc.org/news/why-do-so-many-americans-distrust-science.