NOISE | Aparna Ragupathi
I walked out into the waiting room with my white coat and a clipboard, feeling very unlike myself. An elderly man wearing a wide-brimmed hat smiled at me as I walked to the other side of the divider wall where the patients couldn't see me.
Can't hide the whole day, I thought. I took a deep breath, returned to the man, and sat next to him, ready to ask my quality assurance questions. My voice was higher than it usually was, and my inflections made me sound like a customer service rep. He asked where I was from and when we realized we were both from neighboring towns in south India, I started to find my voice again. We spoke in broken Tamil, and I thought maybe I could do this.
I moved to a couple and kneeled on the floor in front of them, my clipboard resting on the chair that held their bags. They seemed nervous about answering my questions, nervous about me, until we realized we could speak to each other in Spanish. I felt my thoughts slow down and quiet, and when I sat down and leafed through my finished surveys, my face didn't feel hot anymore.
I followed these patients into their appointments, and the anxious noise I had in my head manifested in front of me. For the couple, the doctor used a phone interpreter who was hard to hear, a muffled telephone chatter. The wife became frustrated, and after a while, the husband stopped asking questions. I stood in the corner, trying to make myself smaller, and felt my hands tighten on the edge of my clipboard.
I stuck with this doctor for the rest of the day, watching him navigate his patient interactions. He flew between patient rooms, taking time to review charts before so the conversations could be efficient. Try as he did, we were still always an hour behind schedule.
A patient, who hadn't been to the office in nearly a year, mentioned that life had gotten hectic, and I so badly wanted to ask why. What was wrong? How could we help? I wanted to hold the patient's hand and tell him it would be okay and we would reschedule the tests and get back on track. The doctor did none of this and shifted the conversation to medication refills. I wondered whether this was his nature, but as the day went by and we became more pressed for time, I realized it didn't matter if he wanted to be a parent, a friend or a confidant for his patients. There was limited time. More than anything, they needed a doctor.
And so we rushed. I slipped my questions into the breaks the doctor took while typing or turning a page in the chart.
Towards the end of the day, we met with an impasse: One woman had three CT scans from different months, each showing different results. The only solution was for her to get a CD of the scan and come back to us for another follow-up. There was so much noise: the middlemen, the forms, the click-clack back and forth between offices. The realization—that there would be another delay in diagnosis—and the unlikelihood of a resolution.
In this moment, the doctor put his papers down and explained why her scans might not be lining up. They're shadows, he said, and sometimes people read them differently. He said he would try to pull them up on our computers, and she nodded. He had heard her.
I learned to search for these moments of quiet, slow medicine throughout the day. Few and far between, it was like coming up for air.
During another consultation, a mother referenced research she had done about drug interactions between the patient's medications. The Internet became another voice in the room, one that could become much louder and more convincing than the doctor. But all it took to quiet it was some eye contact and longer pauses between sentences of explanation.
It was the same magic he had used with the scans. It was clarity.
I left the office that day fully aware I had signed up for a noisy career. But learning to be present— with a quiet and engaged mind—I could create moments of clarity for my patients and myself.
Aparna Ragupathi is a second-year medical student at Robert Wood Johnson Medical School. She holds a BA in Journalism from Rutgers University.