Hiding It


Tina Olkowski, MD1

Accompanying artwork: Reid Psaltis

Perm J 2018;22:15-212 [Full Citation]

E-pub: 04/19/2019

This is a story and illustration from the upcoming book 100 Little Stories of Big Moments published by The Permanente Press.

Most of the stories and poems were written by clinicians in 15 minutes in writing workshops about meaningful moments in their work and life of practicing medicine. Professional artists were asked to create a visual representation of the story.

"Always assume the patient is lying," I say as the young medical student finishes his presentation. He tries to maintain a poker face, but there is a perceptible twitch at the side of his mouth. I see this.

I’ve been an Emergency Department attending for 20 years, and I quickly assess people, noticing these things almost at a subconscious level. Sighing to myself, I retract the ugliness of my statement. I soften it, talking more quietly, drawing him in: "Or withholding something, hiding it." The student relaxes. Yes, I guess I don’t have to say patients are telling purposeful lies. Instructing him, I say, "So in each encounter, I usually ask, 'Is there anything else I should know?' And then I sit and stare quietly at the patient. You can sometimes get the most extraordinary additional details."

I send him back to the patient’s room. A whole 5 minutes later, which is a lifetime in the Emergency Department, he returns smiling. I look at him, so young and eager to please me.

"Well, I asked your question and waited," he gushes. "Turns out, maybe she could be pregnant after all."

I smile and pass him the lab slip. "She is."


How to Cite this Article

Olkowski T. Hiding it. Perm J 2019;23:15-212. DOI: https://doi.org/10.7812/TPP/15-212

Author Affiliation

1 Emergency Department, Moanalua Medical Center, Honolulu, HI

Corresponding Author

Tina Olkowski, MD (tina.olkowski@kp.org)

Artist Information

Reid Psaltis lives in Portland, OR, where he makes illustrations, comics, and sculptures about science, nature, and natural history.

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