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The cost of presence: a lesson in listening

Kathleen Muldoon, PhD
Conditions
April 1, 2025
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Last week, a mother of six children—four of whom have disabilities—made the trek to the health care campus where I’m a faculty member to share her story. She’s making this trip weekly on Thursdays to give the same presentation twice in succession for a duration of an hour each time, for five weeks in a row. That’s ten times telling her story to a faceless crowd of interprofessional health care students. It’s ten hours of effort, not including her travel across the Valley, traversing an unfamiliar campus alone, or the emotional labor of standing in front of strangers and asking them to care about her life.

Why would anyone do this to themselves?

Because she thinks it matters—not for her kids, but for your future patients.

I know this mom personally. In addition to being a medical school professor, I am the mother of three children, including a child with 42 active coded diagnoses, and a team of 18 health care professionals who support him. The caregiver community in Phoenix, Arizona, is tight-knit, and within our group, the advocate set is fairly small (although growing lately, out of necessity).

So maybe that’s why, despite the attention of nearly every other student in those double-joined classrooms last Thursday, my gaze landed so directly on the student sitting in the third row, baseball cap backwards, scrolling, scribbling, then scrolling some more on his iPad. Casually and distractingly twirling his stylus pen as he lifted it from whatever he was working on. He was clearly visible to me, as I was sitting at the front of the room managing the streamed video capture and online chat for this presentation. Clearly visible to the speaker, as this student was sitting directly in line with the podium from which she told her story. Clearly working on something completely different than the task at hand—to listen to and observe this mother, sharing the gift of her perspective as a patient caregiver with tomorrow’s health care practitioners.

I did my part. The only thing I could do without creating a scene at the moment. I widened my eyes, drew my eyebrows so high I’m sure they looked like devil horns, and leveled an unflinching teacher/mom glare right at this student—the universal nonverbal signal in polite company to STOP WHAT YOU ARE DOING RIGHT NOW AND START BEHAVING! It didn’t work. I kept that stare up for 40 minutes straight, trying to bore a hole into this student’s heart (and if not his heart, then his brain), wondering how he could be so oblivious to my attempts at correction. I know the answer was likely the grip of some upcoming exam, some grade, some curricular incentivization to focus on anatomical or biochemical pathways instead of real, live people. Not just people—this person. As if anything could matter more than this human before him right now, this connection she offered of one hour of insight into her life. Required for him, voluntary for her.

The only time this student looked up from his iPad was to scan the QR code to mark his attendance at the end of the hour. If he hadn’t packed his bag up so quickly and dashed out the door—without eye contact, or a thank you or so much as a nod to the speaker—I would have pulled him to the side. I was accidentally barricaded by the number of students who wanted to express gratitude to this mom for her story, for her effort, for the information about available services and support. These were the students who were truly present and learned something, even as they, too, had pressures on their time.

I have never met anyone that I haven’t learned something from, especially those who make different choices than I might. If I had been able to stop this student, I’m sure I would have learned something about why he made this choice or why he entered medical school in the first place, or maybe the distance between what he thought medical school would be like or who he was when he matriculated 9 months ago, and what he thought of these things now. Maybe it was better that I couldn’t reach him, because my availability to learn from this moment would have been clouded by my own vicarious trauma as a mother who has had to beg providers to pay attention to my disabled son.

Instead, I bring this message to this community: Future doctors, health care practitioners, and providers, your technical expertise will always matter—But your presence, your attention, and your humanity will matter just as much, if not more, to the people who entrust you with their care. The foundation of medicine isn’t just knowledge; it’s listening, seeing, and truly understanding the lives behind the diagnoses. If you cannot be fully present for one hour of a mother’s hard-earned wisdom, will you be present when a patient sits before you, vulnerable and afraid? Medicine demands more than skill—it demands the willingness to engage, to learn, and to honor the stories of those you serve. We must build a profession that fosters connection, learning, and even discomfort, because in that space, we find not only dignity. We find the resilience to keep showing up, again and again, for those who need us most.

Kathleen Muldoon is a certified coach dedicated to empowering authenticity and humanity in health care. She is a professor in the College of Graduate Studies at Midwestern University – Glendale, where she pioneered innovative courses such as humanity in medicine, medical improv, and narrative medicine. An award-winning educator, Dr. Muldoon was named the 2023 National Educator of the Year by the Student Osteopathic Medical Association. Her personal experiences with disability sparked a deep interest in communication science and public health. She has delivered over 200 seminars and workshops globally and serves on academic and state committees advocating for patient- and professional-centered care. Dr. Muldoon is co-founder of Stop CMV AZ/Alto CMV AZ, fostering partnerships among health care providers, caregivers, and vulnerable communities. Her expertise has been featured on NPR, USA Today, and multiple podcasts. She shares insights and resources through Linktree, Instagram, Facebook, and LinkedIn, and her academic work includes a featured publication in The Anatomical Record.

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