It was only afterward that I wondered if I had been condescending.  The words had come out so naturally.  We were sitting across from each other in the nursing home.  It didn’t take a doctor to recognize that his leg was visibly less swollen.  I had seen him walking down the hallway with the physical therapist, his face a mix of pain, concentration, and triumph.

Each day had brought improvements.  His range of motion was returning, and his strength was growing.  His body balanced now with only the most minimal of assistive devices.  What had once been disability had transformed to normal physiologic functioning.  

In medicine we often talk in the most passive of manners.  We say that the knee is improving or the wound is closing.  We talk as if healing is an act of God; a blessing that is bestowed on the weary from time to time in a somewhat whimsical manner.   

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And I am not a denier that randomness pervades our experience in hospitals and medical clinics.  But I have been trying to be more cognizant of the role that human will plays in the rehabilitation of both body and soul: the force and strength, the sweat and tears, the physical act of becoming healthy.

So I said what was on my mind.

“You know, I’m really proud of you!”

These are funny words coming from a middle-aged doctor to his geriatric patient.  But his face lit up, and I could see that he was thankful for the recognition of the difficult road he had travelled and barriers that still lay ahead.  It wasn’t condescending.  It was a truthful moment that transcended the artificial barriers between doctor and patient.  I was just an innocent bystander acknowledging the remarkable personal will it took to get better.

I frequently feel both awe and pride when I witness the strength and endurance demonstrated by the patients who fill my moment-to-moment existence.  

From time to time, when appropriate, I try to let them know that.