I ducked into the ladies' room at La Guardia Airport in New York for a pitstop before boarding my flight. Inside I encountered a housekeeper washing the floors. She flashed me a broad smile. I assumed she didn't speak English and was using her smile to warn me off the wet floors.
Later, after I washed my hands and was walking toward the exit, the housekeeper stopped mopping and gave me that warm smile again. "Gracias," I said, meaning to thank her for preventing me from slipping on the slick floor.
"Doctora," she replied, and then hesitated. I could see that she was waiting for a response. "Recuerdame?"
Suddenly I recognized her as one of my patients. Once I could envision Senora R. in my clinic, I knew exactly who she was.
"This is where I work," she said in Spanish, gesturing around us. The pride was evident in her voice.
"Como esta?" I asked, astonished that the context of our meeting prevented me from recognizing my longtime patient.
"Doctora," she said, her voice growing serious, "there's actually something I've been wanting to ask about. But the next appointment for you is so far off. Could I …?"
I quickly scanned our surroundings — white tile walls, rows of sinks and stalls, two other travelers jostling suitcases into narrow doorways. But no one was near us by the exit.
"Do you want to tell me now?" I asked quietly, hesitantly.
Senora R. pointed to the edge of her clavicle, right at the base of her neck. "I think this has been swelling. It feels larger than the bone on the other side."
I squinted at her neck but didn't see anything obviously amiss. She pointed again. If I were in the clinic, I would have immediately reached out and touched where she was indicating. But it felt odd, here in the airport restroom.
It was one thing to discuss her medical concern — the verbal interchange was simply a type of conversation. Visually inspecting her neck from my vantage point also seemed permissible. But touching her, reaching across the physical divide, felt as though we were breeching a barrier.
Senora R. continued to point to her clavicle, clearly expecting me to examine it. I considered the logistics of an impromptu exam. The area of her body in question was readily accessible, so no clothing would have to be disturbed. We still had a modicum of privacy at this moment. This problem was clearly bothersome to her. I was heading out of town and wouldn't be back in the clinic for another week.
So I reached out my hand and palpated her clavicles. I could sense her body relaxing as I touched her, as though the very act of a physical exam was itself somehow reassuring. The right side was maybe a touch larger than the left, but I didn't feel anything terribly abnormal.
I asked her a few more questions: Recent trauma? Fever? Weight loss? Chills? Swollen lymph nodes? She shook her head no to all of them. "Then I don't think it's anything serious," I said. "It's probably the natural asymmetry of the body, and maybe you've only noticed it now."
She looked unconvinced. My flight was boarding in 15 minutes.
"Listen," I finally said. "I'll be back at the clinic next Wednesday. Call me or drop by, and we can talk about it some more. If it's really bothersome, we can consider an X-ray."
She thanked me heartily, and, as so many of my patients did at the end of every visit, extended blessings to my children. She also wished me safe travels.
I dashed through the terminal and arrived at the departure gate just as the flight was boarding. As I crammed my bag in the overhead compartment, I reflected on this tiny medical interaction in the ladies' room.
Certainly medicine isn't one of those jobs that you leave at the office when you close the door behind you. Even when you're not fielding late-night or weekend calls, there are always patients who stay on your mind and keep you awake with worry.
Yet as I hurtle through my personal life as a parent, spouse, harried airport traveler or someone just taking out the garbage on Tuesdays, it's easy for me to forget that I am a doctor. That's why I was so startled to see Senora R. out of context, not even recognizing her at first.
The truth is, doctors rarely see patients in the actual settings of their lives, and we have little clue how their medical issues are integrated into the broader tapestry of their multidimensional worlds. I'd always associated Senora R. with how she looked in her pressed floral blouse sitting in the chair next to my desk, patiently waiting for me to tell her what medications she needed to take. Though I knew she had a job, I didn't have any sense of where she spent the bulk of her waking hours.
Now I saw that her work was physically demanding and kept her on her feet all day. I could probably swallow back my routine advice about getting more exercise. I also realized that I probably shouldn't give her medications that would require midday dosing, since she might not have private space or time to take meds. But mostly it was impressive to see her where she was in charge, where she was the one making the impact on her environment. The restroom was spotless, and she appeared to take full, well-deserved credit.
And then there is the issue of the doctor-patient relationship and how it carries over to life beyond the clinic. I'd felt a little awkward conducting medical business in the real world away from my exam table, stethoscope and medical charts, but it didn't seem to bother Senora R. Access to doctors is always a challenge, and an opportunity for healthcare apparently wasn't something to be squandered.
I was honored by Senora R.'s respect and trust. She reminded me why I would choose medicine over an office job any day. She also reminded me that a human encounter — of any type, in any setting — is what keeps us connected in the world.
Danielle Ofri is an internist in New York City. Her newest book is "Medicine in Translation: Journeys With My Patients." She can be reached at firstname.lastname@example.org.