Eye contact
===========

* Liana Hwang MD

*   © 2008 Canadian Medical Association

He was my first patient in East Timor: 12 years old, with a 5-day history of delirium and fever.

I'd just finished my first year of medical school, but what I lacked in clinical experience, I hoped to make up for in enthusiasm, supplemented by frequent consultations of the *Oxford Handbook of Clinical Medicine*. I had never seen or managed a delirious patient before, but, in well-trained medical student fashion, I started by taking a history from his mother.

I followed all the communication “rules.” Introduce yourself. Set an agenda. Signpost. Summarize. Make eye contact.

They never prepared me for what I saw. I'd expected fear, pleading, maybe even desperation in his mother's eyes. I was shocked to see only emptiness and resignation.

He was the first patient to die in my care. When I arrived for morning rounds, the nurses had drawn a black cross next to his name in the register. His mother had taken his body to the church and I waited all day for her return. I never found out what had killed him, whether it had been cerebral malaria, typhoid or any of a host of diseases, which we didn't have the means to diagnose. We treated him as well as we could given that we had run out of most of the commonly used antibiotics and painkillers. (When I asked for ibuprofen, the pharmacist wryly offered me ketamine.)

I never saw his mother again, but I have seen that look many times in the years since. Sometimes I think about how easy it would be to close my eyes.

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/178/10/1270/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/178/10/1270/F1)

Parents are often reluctant to take children to hospitals in East Timor. Image by: Liana Hwang

And yet, in East Timor, I saw why some villagers are reluctant to bring their children into the hospital: a lifetime of suffering has taught them to expect the worst. For a poor villager, the death of a child is an emotional and financial catastrophe since the grieving family is often unable to afford the expense of bringing the body home for traditional funeral arrangements. Eventually, our mobile clinics agreed to cover that cost. A small difference, to be sure, but one that has saved lives.

It's been 3 years since I travelled to East Timor. Outwardly, I'm just another family medicine resident and yet when I look at my reflection in the mirror, I see how I've been changed by the simple act of having made eye contact.

## Footnotes

*   *CMAJ* invites contributions to Dispatches from the medical front, in which physicians and other health care providers offer eyewitness glimpses of medical frontiers, whether defined by location or intervention. Submissions, which must run a maximum 400 words, should be forwarded to: wayne.kondro{at}cma.ca