The Yale Journal for Humanities in Medicine

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Notes from a Healer

Patient Understanding

“I brought my son in yesterday for an earache. The other doctor said he had swimmer’s ear. She gave me some drops to use, but today he says his ear hurts worse.”

I listen to this mother recount her concerns. This is not the first time I have seen her children for minor ailments. I glance at the boy’s medical record, noting that he had been treated for swimmer’s ear last summer as well.

“It does take the medicine a bit of time to work,” I explain, suggesting that things might improve over the next twenty-four hours. I can tell from the look on her face that my words have not convinced her.

“I was worried that he would get worse over the weekend. It’s always difficult to get someone to see your child on the weekend, you know.”

I nod my head and offer a suggestion. “Sometimes the eardrops don’t coat the walls of the ear canal all that well. In the past I’ve done what a lot of the ENT doctors do—insert a wick into the ear. You put the ear drops on the wick, and it swells up like a sponge and holds the medication against the inside of the ear canal. It seems to work a little better.”

This mother opens her mouth to speak, then closes it again. She looks somewhat puzzled. I sense that she hasn’t understood my explanation, so I elect to try again.

“You see, the problem in swimmer’s ear is the inflammation of the lining of the ear canal. We need to get the medicine to lay up against the inside of the canal wall, where it can do its work to calm down the inflammation. The wick will pull the medicine into the ear, much like the wick in an oil lamp pulls the oil up to where it can burn. The wick itself doesn’t burn—it just conducts the oil to where it needs to go.”

I can see that I am getting in deeper and deeper with my attempts to explain the rationale behind the treatment. For some reason this mother doesn’t seem to comprehend what I’m saying. No matter, I think; we will push on.

“Tell you what,” I say, “let me prepare the wick. I’ll show you when I get back.”

I dash out, pulling the exam room door closed behind me, and enter the lab. Using a wad of cotton and a small surgical scissors, I quickly fashion a suitable wick. I search for a sample bottle of prescription ear drops and gather everything together on a plastic surgical tray. I return to the exam room with the paraphernalia like a school boy preparing for show and tell.

“Now then,” I say, holding the wick with the forceps, “I’m going to saturate this with the medicated drops,” which I demonstrate, “and insert this into the ear,” which I do. The boy winces a bit, but calms down directly.

“See here?” I show the mother the end of the wick in her son’s ear. “This is where you put the drops to keep the wick moist throughout the day. The wick will eventually make its way out of the ear. Just keep applying the drops—don’t push it back in—and when it falls out entirely, continue to put the drops directly into the ear. He’ll feel much better by this time tomorrow.”

The mother steps back, somewhat overwhelmed by the explanation. “If you say so,” she says, then smiles. “I trust your judgment. I feel better myself now.”

“I’m glad,” I say, holding the door open. She takes my hand briefly and exits with her boy. She is a lovely woman in her early thirties, albeit a bit nervy, I think.
I return to the desk in my office to jot down a treatment note.

When I open the record and glance at the problem list, suddenly it all becomes clear in a moment. Now I understand why this mother had difficulty comprehending my explanation. Why hadn’t I remembered it before? There, written in my own hand under the heading of family history, the words are recorded along with the date two years ago: “Mother: hospitalized with varicella meningitis, extended coma.”

She hadn’t worked for months afterwards, I recall. Her outward appearance gave no clue to the sequelae produced by the microscopic virus deep within her brain. The vestiges of her former encephalopathy still linger. Not able to fully comprehend, now she can only trust and, like most of us, hope for the best possible outcome.

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine. Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care. His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: July 27, 2007