Followed Dr. W around. I want to be her when I grow up. She's a no-frills, tell-it-like-it-is doctor whose patients adore her and sometimes do what she tells them to. And she's pretty and she's fun and she refers to going to see patients as "playing." She walked up to one of her colleagues one day and asked for a moment of his time. He gave it. "I'm getting numb," she whined. "I just want to take this woman and admit her to the hospital even though she doesn't need to be there." She did, too. Came and found me. "I'm so mad at myself I could spit," she says. "I wussed out."
Last patient of the day, one day, was a mildly mentally retarded woman. Very mildly, note. Comes from an abusive family. Her mother was abused. She was abused. She's married to a schizophrenic man who was put into a hospital after he took an axe to the house. They have a daughter who's been taken into foster care and the court is suing for termination of parental rights. No visitation, no contact, no legal right to even call her their daughter. They tried to get her to divorce him. It takes $200 to divorce him. She didn't have the money. Nobody helped her.
She got a job at McDonald's. She loved it. She started to perk up and bloom. She gained 25 pounds because she didn't really know better than to eat a couple of big macs and fries whenever she was hungry. She did well, though. And then he got home. And after a while, having a job was just "too much for her" and she quit.
Her husband is a man who apparently is at least human as long as he takes his medications. It's when he lapses out of them that he becomes abusive. Sometimes, O Best Beloved, I wonder if the previous statement is self-contradictory. I see so many patients in whom being human can be readily equated with being self-abusive. This man, however, becomes violent. And today, our patient has come with her social worker instead of her husband. The court battle for her daughter is almost over, and the outcome doesn't look promising. She has a handful of papers at the front of her chart - a note written in pencil, careful kindergarten handwriting, giving her stool patterns and talking about her daughter and the meds she's taking. Another note written in blue pen that begins on line 10 of the ruled notebook paper and invents its own meandering margins as it wends down the page onto the very last line and continues to the back. It says the same thing, only it says that she's taking too many medications. She has a spend-down Medicaid. Social Security gives her and her husband per month combined a little more than Angel makes in two weeks, and we get benefits. Two-thirds of her check goes toward her spend-down. I don't understand. The doctor doesn't understand. None of us do, and a sense of impotent fury fills the room.
"He turned to me on the bus the other day and said he felt like he could hit me," she says to us. She's very open with me in the room, in sharp contrast to most abused patients, seems to feel she can trust me. There are tears stinging my eyes already, behind the expression of open compassion. She's quick to continue, though. "He hasn't - but he said he felt like he could."
The woman is shaking, visibly. The whole time I've seen her her body has been trembling with the sort of pent-up energy that only comes with inhuman stress in an only-human container. She looks at us with beautiful eyes, this woman who looks twenty years younger than she is, and speaks in a soft and clear voice pausing and searching for the concepts that elude her mind. We sit silent. The good doctor, high-speed and efficient but never impatient, nods, soberly, answers carefully. There's a pause to let it sink in, watching for the silent cues that indicate a settling of statements onto the psyche. Then she aims the next salvo, slowly, gently, like shims under a recalcitrant door.
"But this is how things went last time," she says. "And last time an axe was used-"
"-and we lost our house." Unspoken: and their daughter.
You don't have to be afraid. And I know, the doctor knows, she knows - that this woman is afraid. Her social worker knows, although by this point he has left the room to give some privacy for the exam. We know because this is how it happened last time, and in a primal portion of her mind that utterly reasonable animal part of her smells the impending conflagration and has begun to scream out for a stampede. And her body responds. She has irritable bowel, hypertension, allergies, esophageal spasm, depression, panic attacks. They were all so very well controlled until he came back into her life.
We change medications, consolidate, take away things that don't work, add new ones in the hope they will. Older medications, cheaper ones in many cases. "I don't want you to meet your spenddown," the doctor says. "Have a little money to enjoy life with." I tell her to get out and walk to work down those pounds. She needs Kleenex for her sniffles and Sprite for her nausea, hugs us both, shows us the pictures of her daughter's birthday party. I look at them, she says, and I feel numb inside. Tears sting my eyes again, make me reach for a Kleenex. I blame it on my cold.
Outside the room the doctor turns to me. "God," she says, and it's part epithet, part evocation, part wish - all these things in her voice with its soft New York accent. "I just want to take her home and make her safe."
I've seen old ladies that I want to grow up into, Mediterranean grandmothers with accents so thick I can hardly understand them, who give even me advice on having children. "Three? Oh, no. Have ten!" Patients bring baklava and lemon cake, cookies and smiles, stop to chat. I've seen frail old women smile and kiss cheeks at the sight of the doctor while others sulk at the misery of their existence. The daughter who looks at the doctor while holding the hand of her wheelchair-bound mother and spills out the fear that her sister will try to sue her for elder abuse just to keep her from spending the sister's inheritance on such foolish things as outings and chances for her mother to socialize. She was in a hurry, she washed her mother's face instead of letting the trembling hands do it themselves, and now there's a bruise near her eye. Her skin is so fragile. The doctor shakes her head, does her best to reassure the daughter. "She dotes," she tells me.
Two days at the end of my week and one at the beginning - the internal medicine doctors, patient, willing to sacrifice time in their schedules - I make them run late, O Best Beloved - to teach me. To let me walk into a room and get to know the patient and then explain it to the doctor. And every day, every patient, every time I walk into a room and do something, it brings me a little closer.
In one year and two months, O Best Beloved, I will be a doctor.