The power of silence: A medical student reflects on the importance of listening to patients

“I’m sorry that you have to see me this way,” said Ms. A as we exited the examining room.

Twenty minutes earlier, Ms. A had been laughing and cracking jokes while my attending physician and I obtained her medical history and life updates. Ms. A came in for a pre-op evaluation and concerns of high blood pressure readings at home. The room was cold, but I felt like we were three friends having coffee and catching up, so there was a familiar warmth. A potent floral aroma stemming from Ms. A’s perfume overpowered the smell of the hand sanitizer. She radiated strength — she was pleasant, funny and talkative. I told myself that those three adjectives were perfect to describe her in the “general appearance” section of my documentation.

In the middle of a Miami summer, where lotion and sweat can be easily confused, Ms. A was impeccable. She was wearing pointy black heels, pastel pink trousers, and a black t-shirt with puffy sleeves. Her hair was voluminous and curly — she would shiftily flip her long bangs to stop them from covering her face.

The encounter started like any other. I asked how she was and if there had been anything new since she last came into the office. Ms. A shared her hardships in trying to get pregnant and how she retired early to spend time with her son, who she often referred to as her miracle baby. Her brown eyes, lined with black mascara, immediately lit up when she talked about how well her son was doing in soccer, in school and especially when she mentioned how much he loves his grandpa. Although Ms. A is part of a big family, she is the only caregiver for her dad. As we listened to Ms. A, tears began streaming down her face. The warmth that had overpowered the exam room had quickly shifted into a cold and somber aura. It would be easy to think that the strength this woman radiated had dimmed, but on the contrary — her vulnerability made her more powerful. We fell silent and gave her the time she needed.

My first instinct was to grab a tissue box next to me and hand it to Ms. A, while my attending said, “I hate seeing you like this.”

Her husband’s infidelity, her dad’s terminal cancer and the isolation from the pandemic were weighing heavily on her. Her household was busy all the time, but she felt alone and without support. Ms. A spoke with a mixture of rage and sadness — her words made me feel stuck and wish I had a magic wand to make it all go away. Her current situation took me by surprise and my head began spinning rapidly with thoughts and questions — how could this resilient, fun and confident woman be in so much pain? And how did she hide it? Am I so naïve that I missed it? How is her son?

After a few seconds, I brought myself back to the encounter. I tried to vocalize some words to comfort Ms. A, but I failed. I was in no condition to say “I understand” or “It will be okay” because…will it? Hard to tell. Do I really understand? Probably not. Instead, I chose to listen.

The traditional Monica would’ve chosen words, some humor perhaps, but in this encounter, I chose silence.

Silence is powerful — so powerful that it encouraged her to be vulnerable with me, a stranger, in the room. She let a stranger examine her and offer her a tissue.

My attending let her know that we were here for whatever she needed and that we would like to see her in two weeks to follow up about the laboratory results. As she left, I said, “Nothing to be sorry about, thank you for letting me be part of the visit.”

Once in the electronic medical record, I had to fill out the “general appearance” statement, something I usually do without paying much attention to the words I pick. This time was different. This time, I stopped and thought about Ms. A in silence.

The cliché quote, “Medicine is an art,” is starting to make sense now. To know when to speak, when to offer a tissue and when to listen is a skill. As a developing medical student, I value moments like these, when my interpersonal skills, listening ability and therapeutic touch are tested. My family medicine clerkship is nearing its midpoint, and Ms. A hasn’t been back, but I hope she finds some silence amid the chaos. She has taught me that sometimes, silence is all we need.