Today at homeless outreach the doctor had to cap the list at ten patients. He had an important meeting and couldn't let the clinic run long (which it often does). Which means that I had to turn people away. Which sucks.

One patient I've known for over a year said "I should be on that list. I was here early but the list wasn't out and then I had to leave."

"I'm sorry, but he can't take more than ten patients today. How are you doing?"

"Not good." Tears. "I wish somebody'd just drive up and shoot me."

This patient has a long history of depression along with a chronic medical condition. Her husband died over a decade ago (murdered, I believe). She's got addiction issues. She looked miserable this morning. And so I decided to say exactly the wrong thing, although it felt honest and true when it came out of my mouth.

"I know how you feel."

I meant I know depression, I know suicidal feelings. I know how lonely it feels. But of course I don't know how it feels to be her (or anyone else, for that matter). So maybe that wasn't the best choice of words. The worst part, though, was realizing that what I'd said had the unintended consequence of appearing to minimize her situation.

"No you don't. You're young. You don't know how I feel." By this point she was bawling and kept repeating her death wish as she walked away. Some people overheard her and started laughing at her as she walked by. (She's been around for years and they've all heard it before, although I still wanted to tell them to leave her the fuck alone.)

However, I was too busy feeling like a total ass.

There's not much the doctor could do for her, honestly. She has all her prescriptions and she was in the clinic last week. I think she just wanted to be around him. He's a very warm, caring, spiritual person and a lot of patients just like talking to him. He makes them feel good.

I feel like I'm going to be good at that part of medicine someday. But what this interaction made me realize was that I have to make more of an effort to understand how the patients see me (as opposed to how I see myself). She looked at me this morning and saw that I was well-dressed and healthy and young and on the path to becoming a physician. I see myself as scared and unsure of myself and as someone who continues to deal with depression and anxiety. But even if I could get her to see me as I see myself, that's not really helpful to her. Or not nearly as helpful as being someone who can be a constant, reassuring presence in her life (like the doctor).

Basically, she doesn't need me to feel her pain. The doctor has a great line for patients who have overwhelming personal histories: "What can I do for you today?" I've heard him say that dozens of times, and it's usually at the point that I'm starting to tear up while listening to the patient's story. And tearing up isn't exactly helpful. The doctor knows he can only do so much, though, and so he tries to keep the patients focused on specific things that can be done to improve their situations.

He seems to have a pretty good grip on the role he can play in these peoples' lives. It's something I'll have to grow into slowly. Right now I still feel so much closer to the role of victimized patient than caring physician.