HEALTH HORIZONS : ESSAY : Learning to listen : Doctors with the patience to lend their patients an ear may find cures more quickly than those who rush into medical intervention.

“Save any lives?” the clinical professor asked the intern each morning after his night on call.

“Oh yeah,” I’d reply. “I ordered three enemas and changed two diets from no salt to low salt.

He wasn’t impressed.

The glory of modern medicine lies in the art of intervention. At least that’s the way it seems: surgeons “labor,” oncologists “battle,” obstetricians “deliver.” Even the lowly intern, exhausted, nervous and nearly completely apart during a night on call, eagerly awaits the opportunity for intervention, for decisive and glorifying action.

Like most of my colleagues, and with my professors’ assistance, I took my opportunities. My patients endured. By the end of my internship, after I had mastered the procedures and managed the heroics, I had developed a clinical instinct that made intervention second nature to me.

It was as if any diagnosis, no matter how hidden, would simply surrender at the sight of a test, or any patient, no matter how sick, would be healed by the pattern of my prescription or the conviction of my words.

But toward the end of the internship I met a patient who showed me that the instinct to intervene might be limiting my patience to listen, and that listening is sometimes the simplest beginning of a cure.

She showed up one day and sat quietly in the waiting room until my last patient had gone and I was alone in my office. The clinic was dark and I was still on call, calculating the hours I might sleep that night if the emergency room was quiet. I was hungry and I had been in clinic all day.

“Dr. Frankel,” she said, her voice barely strong enough to carry above the hum of my thoughts, “can I see you?”

I wasn’t sure I heard her.

“Dr. Frankel,” she said a bit louder, “can I see you?”

I looked up from my desk. A small woman stood in the doorway. She looked nervous, and her eyes moved cautiously about my exam room. She appeared to be in her late 20s. She was modestly dressed and she held a tiny, black purse.

“Have an appointment?” I asked, thinking of dinner.

“No,” she said.

She had waited four hours.

“You’ll need one,” I said.

“Dr. Frankel, I’m sorry, but I need . . . “

“You need . . . “

” . . . to see . . . “

” . . . to call . . . “

” . . . you . . . “

” . . . my nurse . . . “

” . . . today, I . . . “

” . . . tomorrow . . . !”

” . . . can’t sleep, Dr. Frankel, please, I just can’t sleep!”

She stopped. I thought she was going to leave, but she stepped forward toward my desk.

“My name is Miss Hawkins,” she said, pulling a small, flowered handkerchief from the cuff of her coat. “The Rev. Hawkins’ girl.”

She wiped her eyes, folded the handkerchief and tucked it neatly back into the coat. There was a practice to her movements, as if she was accustomed to secrecy. I thought she was crying.

“Why can’t you sleep?” I asked, finding patience in resignation. She swept her hand tiredly over the front of her body. “My stomach . . . hurts.”

“How long?”

“I was 10.”

She was still across the room. I motioned her over and she sat in the chair beside my desk. She was thin. Her blouse was baggy and her slacks drifted sideways and downward from her waist. A long key chain with an open, gold locket hung from around her neck. Inside the locket was a photograph of a little girl.

“My baby’s 9,” she said, noticing my interest in the locket.

I looked again at the photo and smiled politely.

“She’s good,” she said.

I wasn’t sure what she meant, but by now I conceded that Miss Hawkins was indeed my patient, and despite my fatigue I had to care for her. Impatient, I followed the same protocol I learned in medical school, one that I thought would corner a diagnosis on even the most non-specific symptom. I could recite it with blazing automaticity: what makes it hurt, what makes it better, when does it come, when does it go, does it feel like a knife, a pressure, a punch, cold water, hot coal, Well?

What makes it hurt? What makes it better? When does it come? Wwhen does it go? Does it feel like a knife? A pressure? A punch? Cold water? Hot coal? Well?

I got nowhere. So I ordered tests. I ordered blood tests, heart tests, urine tests and X-rays. Did I leave anything out? I wondered to myself.

Miss Hawkins waited patiently. I made a pile of forms and pushed them triumphantly across my desk like a bureaucrat. She glanced at them briefly.

“My sister had tests,” she said, as if apologizing in advance for negative results.

I wondered again if I had left anything out. “Which ones?” I asked.

She seemed preoccupied and she didn’t answer directly. I was getting the feeling that she was worse for having seen me.

“Miss Hawkins,” I said gently, moving from a protocol of questions to a protocol of sympathy, “I’d like to help you. But I can’t help you if you won’t let me take care of you.”

“Dr. Frankel,” she allowed, “why should I take the same tests that don’t even help my sister? I know what it is. It’s me too, it’s just bad in me.”

She began to sob. And I began to wonder, for the first time, if my instinct to intervene was a failure.

“My daddy loved her too. He started around me when I was 10 like he started around her, until she left. Since then it’s my stomach.”

Her sobbing grew louder. She cried a long time. I didn’t speak.

“He was my daddy, but he made us call him Reverend. That don’t sound like a man of the Lord to me, do it to you?”

The clinic was dark and Miss Hawkins was the only living sound.