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Medicine / IN PRACTICE

A gentle touch required

The patient had a lot of requests for his doctor. But as it turned out, he also had precious expertise to offer.

September 17, 2007|James Channing Shaw | Special to The Times

Howard (name changed), an impeccably dressed 83-year-old, first came to my office at the end of a typically busy afternoon.

He was a frail man who moved slowly and had a high-pitched, whining voice that grated on my 4:30 p.m. nerves. He was consulting with me because of a small lesion on his nose and even smaller ones on his forehead. I used magnification as he pointed out each micro-blemish, and then acquiesced to his worries by taking a biopsy of the nose lesion and treating some very early pre-cancers on his forehead with liquid nitrogen spray (we easily could have ignored them for months with no risk to him). He asked to return in one or two months, and with some reservations I agreed to see him at intervals that suited him, thereby adding another high-maintenance patient to my practice.

Two months later, Howard returned, happy with my treatments (thankfully), and showed me new, imperceptible lesions on his face. His tone of voice and plaintive approach had, so far, distanced me from asking about his personal life, so in an attempt to warm up to him, I decided to explore more this visit.

"What kind of work have you done in your life?" I asked.

Howard responded excitedly. "Ohhh! I was an organist and a pianist! I still play the organ at my church! Yes!" His every utterance finished with an exclamation point. I nodded and said, "Very nice."

I decided to disclose that I too played the piano, jazz mostly. Self-disclosure during interviews with patients, like humor, must be used cautiously, because what pleases one patient may insult another, and the interview can easily get derailed. Fortunately, this time, it worked. He was thrilled.

We had a brief but wonderful discussion about the classical pianists in our city -- who played with a good "touch," who didn't. Howard had spent an entire year at university working exclusively on his touch, the control and weight of his fingers on the piano keys. He was so appreciative of the lifelong benefit that he said, "You must be exposed to this method! It is something you can learn! It could improve your playing tremendously!" He offered to teach me, on my piano, as he no longer owned one.

At that point in the visit I pondered, "Who is this old guy? Do I want to get more involved with this quirky man?" More important, would I be crossing professional boundaries? What if it were a young woman who wanted to come to my home to give me lessons on touch? How would the medical board view that? How would my wife feel about it?

Nevertheless, I finally decided to take him up on the offer, and before long, there he was, in my living room, assessing my touch on the piano and teaching his method of touch control. Suffice it to say that what he taught me was the most important piano lesson I ever had. What I learned from him had lasting positive effects, and I have been grateful to him ever since.

My professional relationship with Howard wasn't harmed in the least; on the contrary, it improved. I continued to see him and treat his skin cancers as needed. I even learned to welcome the tone of his voice.

By the simple act of exploring Howard's personal life for a moment, I had the good fortune of turning a somewhat strained professional interaction into a rich and rewarding one for both of us. I don't know who benefited more.

Two years later, I moved my practice across the country. I repeatedly expressed gratitude to Howard before moving, and he always responded with his own appreciation of my medical services, and suggested that I pass on the piano method to someone else.

Recently, while writing these thoughts about Howard, my former nurse wrote to let me know he had died, and the local newspaper had run a gracious eulogy. She thought I might like to know.


Dr. James Channing Shaw is a dermatologist at the University of Toronto and the author of "The Quotable Robertson Davies."

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