RS is a 34-year-old, African female with diffuse abdominal pain, which she has suffered for the past week. The pain is located in the mid-epigastrum and radiates laterally. There is no pain in her back. She describes the pain as dull and constant. The pain is relieved with food. She denies nausea, vomiting, diarrhea, or constipation. She has no other past medical history.

But who is RS?

Ruth lives in Washington Heights in New York, New York - a neighborhood largely populated by legal and illegal immigrants. She recently fled to the United States from Sierra Leone with her two children. Her husband was caught by military officials during their escape. She has been in the United States for about three to four months. She is currently living in a small room with a friend. Because of the constant needs of her children, she rarely has time for herself. She feels depressed and anxious about the future, unsure whether she has the strength to survive in this city and country.

Both versions of her story are important. How are they related? Does she have a pathophysiological disorder like gastritis or an ulcer? Are her physical complaints related to her depressed mood?

For centuries, we, physicians, have been trained to elicit the patient's story. Then, we translate the patient's complaints into symptoms, which lead to a diagnosis. We standardize the individual's story so that we may communicate amongst each other. Our questions are targeted and focused upon the matter at hand. In these times of managed care and time constraint, our interactions with the patient have become further constrained and limited. How do we balance compassion with time?

During my third year of medical school, I watched physicians stride in and out of the examination room of an outpatient clinic within ten minutes. As I sat in the room across from this lady, I thought about the number of patients that were awaiting their appointment in the hallway. I continued to elicit these vague complaints, unable to pinpoint their origin. I was frustrated and prepared to end our discussion with a prescription of Mylanta for indigestion. Then, I decided to ask something unrelated to her physical complaints: "Why did you come to the United States?" It was an open-ended question that gave her the freedom to lead our discussion. She looked up at me with weary lines around her eyes, frightened to reveal her story. For a moment, she hesitated to begin. Then, a flood of images rapidly came into our interview: the cramped, dark room in Washington Heights, the other stowaways in the ship across the Atlantic, and the soldiers surrounding the house. Tears welled in her eyes and began to fall; I actively listened… the most important skill that I have used in medical school.

Compassion is not something that can be constrained by time. It need not be sacrificed because we have only ten minutes with a patient. Our compassion stems from the varied backgrounds, talents, and interests we developed before entering medical school. The undergraduate years are a time to explore and engage in these interests, whether they involve scientific research, music, or sports. These are the embodiments of compassion, because these activities make us human. They allow us to share the human experience.

When a patient begins to grasp her chest, finding it difficult to breathe, and is unable to speak, you roll her stretcher to a monitoring station. As you place her on 100% oxygen, your mind is focused upon the tasks at hand. Step by step, you follow the methodology learned in medical school: giving her an Aspirin to chew, placing EKG leads on her chest, and calling for a cardiology consult. In the back of your mind, you know that there is a chest X-ray in radiology you need to glance at, that there is Tylenol you need to give a patient upstairs, and that lunch/dinner has passed.

During this time, I hope that you remember to take the extra five minutes to remember that this patient has a story outside of her present symptoms. She is not just a cardiac patient with hypertension and diabetes, but a mother of two or an elderly woman who was a figure skater in her youth.