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Revisiting the Past (Part I)…

March 31, 2012

I readily admit that my blogging has fallen to the wayside. Life happens…and in the fourth year of medical school, Match Day happens, and that only means one thing: weeks of anxiety mitigated only by boxes of Girl Scout Cookies and daily (almost hourly) social events.  This is all to say, I’ve been rather neglectful of this project. But, I have a peace offering (to any of you out there who still check back once in a while)…I found this “essay” while cleaning my computer files, and so I submit it to you as a place holder until I jump back in this saddle:

Mirror, Mirror on the Wall…(written in April 2009 – as a 2nd year Medical Student)

Days. At least. Well, hours at the very least.  She had practiced and rehearsed it.  She had watched herself in the mirror, watched as her lip quivered less and less with each repetition.  She had anticipated the line of questioning, the chastising tone of her inquisitor.  She had bolstered herself against the onslaught of “you should be’s” and “you could do more’s.” She had shrugged off her mother’s words of encouragement, the kind awkwardness of an adult who is so close and yet…so far.  As she was ushered into the room and handed a clipboard, she knew this was hers to have.

* * * * * *

Day in and day out we have had already begun to see the office as just another room…something of an appendage.  It is an extension of ourselves, rudimentary scripts and a burgeoning muscle memory guide us effortlessly (well, at the moment, effortfully) through the myriad of questions, auscultations, palpations and special tests.  Like our patients, we have practiced and rehearsed – many of us in front of our own mirrors, in the shower, while cooking dinner, with each other, on each other – exactly how our visits will go, all in anticipation of not completely losing it in front of a patient, or even worse, screwing up so badly that they know we are a fraud.

On this particular day however, it wasn’t just me who feared being unraveled.

* * * * * *

What she hadn’t calculated, was the middleman…and in this case, there were two.  “Just, um, just be gentle with her okay? She hasn’t had a good week, and this is really weighing on her.  She doesn’t need you to beat her up over it, and it might be nice if you said something encouraging, something to lift her up a little bit.  I just don’t want her to hear the horror stories…okay?”

Nodding with matronly affirmation, the doctor responded, “Well, I don’t really believe in sugar coating anything…if it’s really something we need to worry about then I’m not going to tell her all is well…you know?” And with that, Mom was sent back to the waiting room.

“So, Jessica, how are you?” “Fine.” Typical sixteen-year-old answer, right on par for the, “you-said-I-have-to-be-here-so-I’m-here-now-let’s-get-this-over-with-so-I-can-go” attitude. Indifference – check. School, friends, sex, drugs and rock-and-roll later, it had finally come to the one thing both parties had been dancing around: “Do you have any questions or concerns for me?” There it was…the opening…if she wanted it…if she could muster it up.  Silence. “You’re Mom said you’re concerned about your weight.”

Done deal.  She hadn’t known that simply hearing the words – even in one of their most benign forms – would set her off.  All of that time, all of the pressure…wasted, wasted as her lip quivered and her eyes blinked furiously to dam the coming flood.

“Do you have concerns about your weight?”

Silence.

“Jessica, I know this is hard for you, but you need to talk to me.”

Silence…and a hiccup…her hands wiped both cheeks, her eyes continued to be fascinated by nothing on the rug.

“Okay, let’s take a look at the chart.”

* * * * * *

Sometimes we have a difficult time figuring out how to best convey our scientific and medical knowledge to the people we are caring for.  I suppose the fortunate thing for me, at this point anyway, is that I don’t really know enough to get lost in the jargon…but I can only hope that as I purchase more books and make more study guides, I don’t lose the ability to speak my native tongue.  Needless to say, sometimes our need to look at numbers and graphs and tables obscures the fact that there is a person sitting in front of us, and certainly, the “How Fat Are You?”[1] chart is no exception.

* * * * * *

“You’re weight is creeping up there, it’s not dangerously overweight, but it is overweight.”

Forget it…composure: lost.

Pride: out the window.

Hating life: certainly reached a new level.

Tears streamed and even a box of Kleenex wasn’t enough.  The worst part? No words…after all the time spent saying it to herself, she couldn’t say what she needed to say…it just hurt too badly.  And so, as the doctor continued to speak for her, to talk about the ways in which she could modify her diet and her exercise, and how sometimes it’s just the “luck of the draw, I mean, clearly I struggle with it too,” Jessica sat, in what I can only imagine was disappointment, shame, anger and spite.

* * * * * *

It is probably a lot to assume the things I have just described…and it is probably unfair to speculate about the emotions of a high school sophomore girl.  But I don’t think that such conjecture is for naught – sometimes I just need to know what it feels like. I wonder though, in trying to feel what my patients feel, if I don’t do myself a bit of a disservice.  Am I then too connected, too into their story to be able to effectively manage their health? Will I be able to get to the heart of the matter when the subject gets tough?

I have managed to figure out (at least most of the time) how to dissociate during emergency situations – distancing myself enough to get the job done (okay, so my “emergency” experience has been admittedly limited, but every little bit counts, right?).  I have not, however, developed the best way to do so during a benign, yet emotional circumstance.  I know that I have a great deal of practice to look forward to, and as there already has been, a great deal of rehearsal in front of mirrors and in showers. And, like Jessica, I suppose that I will have many (valiantly) failed attempts ahead of me, before I get to that one moment, in which it finally clicks.


[1] The “How Fat Are You Chart” refers to the development charts (height, weight, BMI)

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