IF ONLY | Julie Hwang

My Grandmother’s Medical Check-Up

“Don’t worry, this is common for people in their 70s. We’re all getting old aren’t we?” he said, and laughed.

Even before I could give my emotional flood a chance to recede,
he was already past my diagnosis, onto the procedures: the scans,
the surgery that I, once again, wouldn't have to worry about.
He constantly emphasized the 95 percent success rate.
5 percent never felt so probable before.

...all this, facing the screen, his back against me.

“I ordered a CT scan for you,” he said. “It shouldn’t take too long.
Just need some time for the IV contrast dye to enter your veins.”
The moment I heard the word contrast dye, my heart sank.

“Contrast dye?” I asked, with my voice trembling.

He nodded, still facing the screen, and explained,
“Yes, contrast material blocks x-rays and appears white on images, can help emphasize blood vessels, intestines...”

That’s not what or why I was asking.
I was scared.

“Are there any....”
Before I could finish my sentence with alternatives, he said with a smile,
“The nurses will walk you through each step, so don’t worry.”

He knew I was married. Had siblings. Had kids.
But what he didn’t know was that years back,
I had to say my last goodbye to my younger sister when she passed away due to an acute renal failure due to complications caused by the contrast dye.
I was scared.

If only my fears were acknowledged then.
If only I was acknowledged whole.
If only...

Then maybe, maybe then I can smile,
smile even though I am at my most vulnerable, sick and confused
but still, find comfort in that I am in fact being heard.

________________________________________

Introduction

The script above, accompanied by the visual rendition of the story below, is an anecdotal encounter my grandmother had with her physician a while back. Although I first heard this story when I was younger, I revisited the story from a slightly different angle after completing my undergraduate degree in Visual Media in Narrative Medicine. I applied the theoretical lessons of not equating patients with their diagnosis to conceptualize the kind of interaction I wish to have with patients in the future as a physician. Using the stylistic approach of photomontage, photo mosaic, and photorealism, I crafted a visual representation of what it means to really hear and care about both what the patient presents and their background story as a whole. The essay following the story provides an analysis of each image, the particular stylistic approach, and a discussion of the implications of my grandmother’s experience on my future medical education.
* * *

The possibility of having to undergo surgery in itself was a huge shock for my grandmother. However, what made it even worse was the fact that her trauma regarding contrast dye was not acknowledged at all. Decades ago, her younger sister, after years of kidney dialysis, passed away when the contrast dye she received for a CT scan led to an unexplainable renal failure.

Nowadays, the fear of contrast dye could seem trivial. With all the medical advancements and breakthroughs, the protocols and precautionary measures taken before a CT scan are rather mundane, commonplace procedures.

For my grandmother, however, it was a trauma that still deeply affected her. Yet, the physician turned a blind eye to her fear and left it a story untold.

To illustrate her experience, I utilized the stylistic approach of using smaller images overlapping my grandmother’s portrait, ranging from a somber expression to a big smile, to depict that the smallest differences within the physician-patient interaction can have a consequential impact on the patient’s overall medical experience. Moreover, the compilation of numerous tiles that represent different images making up the face illustrates how it is the consideration of the various factors, not just one aspect, that lead to the overall experience.

The first three mosaics have a darker hue and expression compared to the last..

In the image to the right, the two smaller repeating images making up the mosaic pieces are of physicians and residents with big smiles, symbolizing good intention. The overall hue and expression is dark because, although the physician means well, based on the dialogue, his immediate response was to provide reassurance based on the facts and figures instead of asking questions about what the diagnosis could actually mean to the patient. All the physician did was to brush it off by saying “This is common, don’t worry.”

In the second image, the smaller pictures symbolize attempts at finding a “cure.” The mosaic includes a scene from a clinical case study meeting, the operating room, a medical conference and imagery of fellows and residents making rounds at the inpatient unit. However, in the first image, the patient is anxious and confused, with medical jargon, complex procedures and talk of medical research overwhelming her. The two pictures indicate how medicine can often be intimidating for patients when the sole focus and what is communicated to the patient is the scientific knowledge and skills.

The image to the right is a little less somber in terms of the hue because it is taking a step towards integrating care into medical treatment. The old photographs represent information available to the physician from the very first encounter. The physician knew my grandmother’s basic family history of her sister's death. As she was about to explain to him her concerns related to her sister’s death and the procedure, he cut her off and went into the medical details of the procedure instead. Because he didn’t give her time to express her concerns, he never found out about why she was afraid: not because of the procedure itself but her trauma associated with contrast dye and CT scans. This highlights how oftentimes, the patient-physician dialogue stops short because the physician interrupts the patient. In fact, several studies show that doctors cut off a patient after eight seconds, on average, when the patient is telling their story.

When zoomed out from the smaller squares, my grandmother is still a confused and apprehensive patient.

The final image, the first one to have a lighter feel, is the one that captures the idea of curing the disease and caring for the person. It’s what the patient hopes for: to be viewed not as a pathology, a diagnosis, or an intriguing case, but an individual with a story to tell. The images include pictures from previous mosaic pieces, the aspects of medicine that my grandmother needs as a patient: the science and technical aspects of medicine. However, it also includes new images shedding light onto who my grandmother is as a person: the final picture she took with her sister and the friends she spent time with after her sister’s death.

Overall, the project highlights the problems that can occur when physicians and the healthcare system try to simplify or dilute patient narratives to a single diagnosis. The patient is so much more than what is seen through the medical lens, as suggested by the different mosaic pieces that constitute the patient. Even to this day, this one encounter left a scathing scar in my grandmother’s heart. However, to the doctor, though well-intentioned, she was just another patient, one of many he had that day, that needed a CT scan.

While medicine is about curing the illness, it is also about giving the patients a chance to speak for themselves, to share their fears, and most importantly, communicate their stories. Without being in touch with the stories the patient has to share, without attaining to the cultural needs of the individual, without treating them as human beings first, science alone does not mean much. Only when these different pieces come together can we call it true patient-centered care.
** I would like to extend my gratitude to my grandma who believed in the power of vulnerability and was willing to share her story and experience as a patient.

Julie Hwang is an aspiring physician who hopes to integrate both the wonders of science and humanities to make medicine a holistic healing process. She graduated from Duke University, where she studied Visual Art in Narrative Medicine. Her piece, If Only..., was inspired by her grandmother’s account of a clinical encounter in the past. The story highlights never losing sight of the person behind the illness and the lived experiences of each individual. Hwang hopes to reflect and embody both concepts in her future medical practice.

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