There are some patients I saw during my time in residency that truly changed me as a person. I've written about a few, but there are many more. Here is what I have to say about one of them. Names and other personal details are of course altered for privacy.
I took a deep breath, forced the best smile I could, and turned the doorknob. Inside, Rosa sat in her wheelchair like usual; a few months ago we had celebrated her regaining her ability to walk with a cane after her stroke, but she quickly went back to the wheelchair as it was easier for her. Today was our monthly meeting to discuss her chronic conditions. In medicine we call this secondary prevention. Primary prevention is focused on keeping someone from having a serious event like a heart attack or stroke, while secondary prevention tries to minimize the person's risk of another event occurring. We are trying to keep history from repeating itself. Rosa and I had been working together for nearly a year at this point, although perhaps "working together" is a misnomer; our appointments generally consisted of her giving one word answers to my questions, me setting some homework that she would promise to work on over the next 2-4 weeks, and then a short period of silence where I tried to discern something about her true mindset or intentions. No matter my approach, I had never gotten any closer to her. And she had never done a single thing she told me she would do. She never checked her blood sugars. She never drank less soda. She never took her medications. She wouldn't take walks or eat vegetables. And she would never tell me why. She just showed up, timely and polite and unknowable, for every visit.
As I entered, Rosa's aunt and caretaker glared at me silently from the corner - both aunt and glare cornerstones of our appointments.
"Hi! How are you today?" I asked Rosa.
She promptly burst into tears. Her caretaker made no move from her seat across the room.
The deluge lasted at least five minutes. I sat in silence with my arm around her, flabbergasted. Where has this come from? She had never given any sign of sadness before. I handed her a stream of tissues, mute in shock and witness.
When it was over, she sniffled one final time, sat up straight, and said, "I'm fine."
I almost laughed. "Rosa, what do you mean you're fine? You basically cried on my shoulder for the past few minutes."
"I'm fine."
I pressed her but got little in response. She wouldn't tell me why she felt so sad. I asked if she wanted to try counselling and she said no. I asked if she was feeling depressed and she did say yes, so we agreed to start an antidepressant that day. A month later she came back for her check-in. She hadn't taken the antidepressant. When I asked her why, she shrugged and said she felt better, and wouldn't elaborate. And so we fell back into our routine.
One day after maybe two years of this pattern, I walked into the room not with my previous forced enthusiasm but with the sort of calm, professional blankness
that comes with knowing you are about to have another pleasant but
fruitless encounter. In hindsight I can see that the lack of progress had been wearing me down gradually, but at the time it felt like an abrupt change. After our usual exchange of Hi-Rosa-how-are-you-I'm-fine, I simply said:
"What do we need to talk about today?"
"I don't know."
"Well, would you like to talk about your diabetes today?"
"Not really."
I paused. "Okay, then. What would you like to discuss?"
"I don't know."
Always previously, I had pushed past her recalcitrance, prodding her to
some sort of lopsided discussion about her medical conditions,
behaviours, habits, and so on. After all, why
else would she come and see me? I had been determined to help her in some
small way. But that day, hearing her respond so casually - not really, I don't know - I
was suddenly furious. So much effort. So much time spent with her.
So many clinics where I let myself run late to attempt to talk to her.
And for what? So that after years of this, she could flush our agenda
down the toilet as though none of it mattered. Just like
that I was done. If she wanted to waste this time, I was going to
let her.
"Okay... well do you need refills of any of your medicines?"
"I don't think so."
"Anything you need from me today?"
"No, not really."
"...Well, okay then."
The visit was over about a minute later. I never saw her again.
I still struggle with the choice I made that day, born as it was from the cliff's edge of patience. Perhaps I did the right thing externally, but internally I gave up on her, and that alone makes my judgment questionable. Should I have kept pushing, had more compassion and perseverance? Was I serving some vague therapeutic purpose? Did I set us both free from a pointless rut we had been stuck in? Or did I just cut off a source of easy emotional investment that she wanted but didn't want to work for?
The truth is probably buried somewhere in the middle of all of those possibilities. I don't claim to see it clearly. After she stopped coming to see me, I prayed for her and prayed for her, and then I got angry at her again and shouted at God about how ridiculous the whole situation was. And ultimately I trusted Him to redeem it all for good. And this is the nature of medicine and ministry, right? Many times it goes nowhere that we can see. Often in this field there is what psychologists call a complex separation from our patients, one without closure or denouement, and thus also without any kind of satisfaction on the part of the provider. It is stressful but unavoidable. Most of my career I will attempt to take care of someone the best way I know how, and I will never know in this lifetime how it really turned out. And in the midst of that uncertainty, in those stories that seem to stop at failure, I can choose to let my viewpoint be similarly limited or I can look further out and further ahead. I can shout at God and be done with it, or I can choose to trust that He is the author of redemption. He makes all things new and good in His perfect timing.
I'm still coming to terms with that.
