In the days after the earthquake, I understood presence differently than I had before. Before, presence had meant attentiveness. Listening to a patient. Not being distracted. After, I understood it as something more demanding. Presence is staying mentally available when another person is frightened. It is not leaving someone alone inside their fear while you finish your work. I had been terrified during the earthquake. I knew, now from the inside, what it was to be in a situation I could not control, to feel my heart racing and my hands shaking, to descend thirty flights not knowing whether the building would hold. That knowledge made me sharper around frightened patients, because I could see the fear more clearly for having felt it. A patient would tense in the chair and I would think, your nervous system has activated, your body is doing what mine did on those stairs, trying to protect you from a threat it perceives. Instead of stepping past the tension to keep working, I started stopping. "I can see you are tense. That is alright. Tell me what you need from me right now." Often the answer was simple. Slow down. Give me a break. Let me know you are aware that I am frightened. That is what the earthquake clarified for me. Presence means witnessing another person's fear without dismissing it and without hurrying past it. In the chair, a patient cannot see what you are doing or control what happens. They have to trust that you are competent and that you are watching out for their comfort, and that is an enormous vulnerability to hand to anyone. A clinician who is truly present is not only completing the technical task. They are receiving that vulnerability and treating it with care. There was a patient, not long after, who was very anxious, tense, asking repeatedly whether I was finished. I could have sped up, or offered an empty reassurance that everything was fine. Instead I said, "You are doing well. I can see you are nervous. We are making progress, and I will keep checking in with you." And I slowed down. I explained each step a little more. I paused more often. What should have taken longer did not, because the patient was less tense, cooperating more, breathing more evenly. The presence made the work more efficient rather than less. That is the part people underestimate. Staying present with a frightened patient is not a soft skill set apart from the clinical work. It is clinical skill. It improves the outcome, the efficiency, and the relationship all at once, and it is worth every bit of the effort it costs.
