The Resilient Heart
He was applying for a job on a refuse truck working for the City. This is a very good job for someone whose hiring prospects are otherwise limited. Excellent benefits, all state and federal holidays off, health insurance for oneself and one's family, physical exercise in the fresh air. (All right, this was Camden, New Jersey, so exercise in some kind of air.) And one more plus: If the team is efficient and hardworking and get through their rounds by 11:30 am or noon, they can take the rest of the day off, yet get paid as if they'd worked the whole 5 am-to-1 pm shift.
I was the doctor doing his pre-placement physical exam--designed to determine if the potential employee has medical conditions or takes medicines (or recreational drugs) that might interfere with the employee "performing essential job functions in a safe, regular, and reliable fashion."
He was twenty-five, slender but muscular, and very excited about the prospect of this job. He was polite and engaging. He surely was capable of lifting cans into the "load-packer" and running beside, or hanging onto the side of, the trash truck as it went on its rounds cleaning up the City.
I took a basic medical and social history. No medicines, a nonsmoker, no prior work injuries. All good news. Never graduated high school: "I ain't no scholar, that's for sure."
Some marijuana use in the past, but "I don't do that shit no more, doc, I got a family to take care of."
"Have you ever had to be in the hospital overnight, besides being born?"
"Well, yeah, doc--I got a surgery. I got stabbed in the aorta."
He proudly opened the flowered cotton gown to display a raised, thick, vertical scar that bisected his chest between his impressive pecs. Just below, I saw a smaller, horizontal scar--surely the entry point of the assailant's knife.
I had believed my patient's declaration even before I saw the scars, knowing from our previous conversation that the word "aorta" was unlikely to be part of his everyday vocabulary. Clearly, he'd been schooled in essential anatomy during his stay at Shock Trauma (or, as the Trauma Center was locally referred to by docs and layfolk alike, "Shock-a-Rama").
Despite this incontrovertible visible evidence, I was amazed: The aorta is the largest artery in the body, and direct trauma to it is almost invariably fatal.
"Yup," he said, nodding at my thunderstruck expression. "Got me right below my breastbone, and even nicked my heart."
"Oh my God!" I sputtered. "What happened? Who stabbed you?"
"Well," he admitted with a wry grin, "It was my baby-mama. We was at a wedding, and we was drinkin', and we got to arguing, and she stabbed me. The paramedics said if I hadn't been drunk, I'd a been dead."
What a sobering tale. A wedding disrupted by a crime of passion. A drunken altercation that nearly led to a young man's death. At least one child's life forever altered by this terrible happening: Mother attempts to murder Father. I was appalled, but did my best to conceal it.
I couldn't control my curiosity, though. Fearing the answer, but feeling compelled, I asked, "Where...where is she now?"
"Oh," he replied casually, "She home with the children. Now we has four. Oldest is seven, youngest is almost two. I didn't press no charges, and she didn't have no record, and we carried it off, with the state defender helpin', as a sorta 'tragic accident.' Now I is quite careful not to look at other women, and we has no problems."
He smiled, his excellent teeth gleaming. His optimism was infectious.
I finished his exam, my head in a whirl, and reported to the City that this man was well-equipped to be employed.
Shaking my hand vigorously, he thanked me again and again. Yet I had done nothing extraordinary. I had just told the simple truth-this man was clearly capable of doing the job to which he aspired.
"I can't wait to tell Maria and the kids; they is gonna be so glad."
In the days that followed, I couldn't help but wonder about my patient's life. Having little data with which to develop an accurate picture, I was left with questions that surely reflected my own view of the world rather than his.
I've tried to envision this happy-go-lucky, plucky survivor in his own world. He will now have a steady job--which will, among other things, pay for his family's medical care. When he comes home some weeks hence smelling of trash truck, will he toss his toddler gently into the air and listen happily to the excited squeals that mean "Daddy is home"? At night, when he sleeps, will his woman trace the scars on his chest with tentative fingers and reflect?
My patient and his family life are foreign to me, yet they have intersected mine via a thirty-minute pre-placement assessment. I want, I need, I hope to understand. I crave to know the secret of my patient's resilient heart--to fathom the bedrock truths that allow him to smile, to hope, to maintain his family intact.
My patient's world view--his truths--must possess awesome power and healing force. Witness the fact that this man's wounds (the devastating physical ones and the no less complicated emotional ones) have been overcome, and that he remains a joyous, hopeful soul who exults in his connection with his woman and children. The result? Six people (some might call them disadvantaged) are bound by history, circumstance, routine and, clearly, love. They have endured and survived as a cohesive unit. Together, as a family, they have endured and transcended a most shocking instance of violence.
When I feel depleted, when my husband and I quarrel or one of the girls brings home a less than ideal report from school, I try, before reacting, to think about my Man of the Resilient Heart. How important are our relatively small problems compared to his past and present challenges? I aspire to attain his level of commitment to family and his incredibly learned acceptance of the imperfect in the people he so dearly loves.
About the author:
Paula Lyons is a native of New Jersey who graduated from Emory University School of Medicine. She now practices family medicine just outside of Baltimore, MD. Some of her other writings have appeared in The Pharos and The Journal of Family Practice.