1. Jimenez, Rosalinda R.

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Another Monday rolls around, as I trudge into the psychiatric clinic. A patient's name catches my attention. I ponder if he's having a good day, compared with the many bad days he's had this year. It's been a struggle with medications, family crisis, and his battle with mental illness.


Mechal*, age 58, was diagnosed with schizophrenia in his late 20s. Along with lost jobs, failed relationships, and a daily tussle with God, he's been under the care of multiple providers who, he claims, don't understand me.


"Good morning, Mechal. How are you feeling today?" I ask, assessing his state of mind and overall health. He is dressed in clean clothes. His hair is clean and combed, shoes are neatly tied, and appearance is calm. Mechal responds, "I haven't had any problems these last couple of weeks. I'm doing what I'm supposed to be doing."


"Mechal, tell me about how you're 'doing what you're supposed to do.'"


"Well, I know I'll always be like this. I have to do what they tell me and I should be OK."


Mechal appears as one who has been in a prolonged battle. I feel deep compassion for him.


We can only imagine what patients like Mechal endure. He describes his mental illness as living in two worlds: the real world and my fake world. He says sometimes his fake world gets in the way of the real world; then things go wrong. His medications can lead to intolerable side effects.


Isolation is another component. Mechal prefers to be alone so he doesn't hurt anyone else.


My plan of care included a broad safety net with resources within easy reach-a plan of education, medication compliance, a support system to help with compliance, daily journaling of moods and thoughts, a support system for crises, home visits, counseling, and a follow-up appointment. I added daily meditation and prayer for self-reflection. I asked how he felt about the plan. Mechal smiled.


"You see me," he stated.


"I'm sorry, Mechal. What did you say?"


"You see me."


"I see you? Yes, I can see you."


"No. You see me," he repeated forcefully.


What was I missing? "Mechal, tell me what you mean when you say, 'You see me?'"


He touched my hand. With tears, he repeated, "You see me. You see my fight. You see my cross. You see me."


Patients want dignity and tenderness. Entering a relationship without preconceived judgments allows us to see the other without conditions. Unlike dominance or a mere transaction between the consumer (patient) and the product offered (provider's service), Buber proposes a chance to equally see each other and gain a bond of trust (Buber & Kaufmann, 1970). This bond engages the I-Thou experience. Seeing beyond the examination, the diagnosis, the symptoms-seeing the other as in a transparent state. Buber calls this experience holy: seeing the other as God sees.


Patient encounters involve a rigorous litany of tasks. It is difficult to see beyond the chief complaint. Taking a moment to welcome holiness beyond the questions, the allotted visit time, the procedures, may not be possible. And yet, providers need to see patients, to recognize the drudgery they endure. In doing so, a strong patient-provider relationship can form.


Each patient embodies a story of illness, a new problem, a social situation, or a belief. William Osler noted, "The good physician treats the disease; the great physician treats the patient who has the disease" (as cited in Bliss, 2007, p. 170). Knowing a patient's background helps establish rapport, respect, and empathy. Providers can then see more deeply, searching for the patient's story.


I saw Mechal as I see all my patients: with mercy, kindness, and humility. But I also saw his daily toil. Knowing that someone recognized his struggle impacted him. I'm reminded of Micah 6:8 (NAB): "You have been told, O mortal, what is good, and what the LORD requires of you: Only to do justice and to love goodness, and to walk humbly with your God."


I imagine Jesus was present during that encounter, helping me see Mechal.


Bliss M. (2007). William Osler: A life in medicine. New York, NY: Oxford. [Context Link]


Buber M., Kaufmann W. (1970). I and Thou. New York, NY: Touchstone. [Context Link]