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Evan Heald

A Different View

Most days, Mrs. Finch's perspective was outrageously optimistic and embarrassingly complimentary. Although she had the typical assortment of nonagenarian maladies, she would not let that define her; whenever she visited my office, it was hard to get to a chief complaint because of her relentless focus on how nicely the parking lot had been graveled, or "what a sweet, sweet nurse you have," or my partner's haircut or the "clever, clever little hooks" holding the geraniums at the entry.

Never mind the treasure trove of doubled superlatives she saved for me, her physician.

She was the grandmother of burly loggers and dairymen. Their heavy boots left red clay castings in my exam rooms, but she dressed in stockings and heels for every visit, and her floral cotton dresses were crisp and perfumed.

She sang her praises in an aristocratic Southern accent that bestowed significance on the mundane and gave her the authority to comfortably address even male physicians as "Honey." Most often "Honey" was delivered in a high, syrupy falsetto.

She obviously found it difficult to sustain this elevated pitch through an entire sentence. Unpredictably, the falsetto would break, leaving her fleetingly a baritone. Then, just as quickly, her voice would soar again, leaving her regal bearing only slightly undercut by the tricks played by her straining vocal cords.

When Mrs. Finch came to the office, the effect was that of a visitation, not an appointment.

Today, though, she appeared totally deflated. Rather than flooding the office with appreciations, she retreated quietly to an exam room and shrank into the chair.

When I asked how she was, she choked, "Oh, Honey, not good! Not good at all."

"What's wrong?" I gasped anxiously. I had never seen her like this.

"You know I had my cataract surgery...." she stammered. Her furrowed lips trembled, and she was unable to continue.

Now I was really alarmed. I had performed a perfunctory preoperative evaluation two weeks ago. What had I overlooked? How had she been harmed by my reckless distain for what I'd viewed, until now, as a wasteful exercise?

"What went wrong? Did you lose your sight?" I probed, dreading her answer.

She regained a modicum of composure. "Oh, no! The surgery was perfect. They were lovely, lovely people that you sent me to. I can see just fine, Doctor. So much better!"

"Then what's wrong?" I pleaded.

"Doctor," she moaned. "I have wrinkles!"


Ms. Virginia

Tell a story about Ms. Virginia? She was the storyteller. Especially when it came to her family. A wizened African-American woman in her eighties, she slouched amid piles of mismatched sweaters in a wheelchair borrowed from the office, her wild hair sporadically punctuated by curious, childish braids.

If allowed the time, she would spend all afternoon telling her lively stories--full of wide-eyed, knowing glances, colorful characters, teasing innuendo and pregnant pauses. Why, it was no wonder we never got to the bottom of those leg ulcers that never seemed to heal.

Yes, she was keeping her legs elevated.

"Did I tell you about how my daddy used to farm an island in the James River?"

Yes, she was wearing the support stockings.

"He never learned to swim."

Yes, she was bathing them daily.

"He took a boat to his fields every day."

And here were the same fetid sores and sodden dressings as before.

"Tipped over in high water, and he never got to shore."

"Why won't these heal, Ms. Virginia?"

"I can't stay here all day, Doctor. I need to get home." Her grandkids (a second-grader and a fourth-grader) would be getting off the bus soon. Their mother was out of the picture.

...No progress on the ulcers. Again.

When winter came, I asked the home health wound-care nurses to see if they could help.

They found the house as cold as the snow outside.

Ms. Virginia, wearing her perennial layers of sweaters, was propped up in a chair where the grandkids had lovingly placed her (and likely braided her hair) before going to school.

The kitchen was barren. She did have some water within reach, but could never have gotten herself to an indoor toilet, much less to the home's outhouse. A puddle of urine surrounded her chair and saturated her dressings.

How long were the children away at school each day? Who was taking care of whom?

Ms. Virginia assured the worried nurses that the children's father, her son, would be right back to load the wood stove and fill the refrigerator.

"He's working hard to keep the family together since that no-good woman left," she said. "You just missed him."

But the two-day-old layer of snow on the walk outside revealed only the traffic of children. The only adult marks were the nurses' footprints.

Yes, Ms. Virginia could tell stories when it came to family.


About the author:

Evan Heald is an associate professor of medicine at the University of Virginia. His interest in writing reaches back to the encouragement he received from Mrs. Lewis and Mrs. Sinha, his fourth- and fifth-grade teachers at Margaret Beeks Elementary. "I have been noticing and participating in medical stories for almost thirty years. Putting them on paper is a more recent development that has its roots in a Macy Humanism in Medicine Fellowship, and also in an ongoing UVA project that encourages internal-medicine residents to look for and appreciate the narratives in their patient encounters." Evan lives in Ivy, Virginia, with his wife, Susan; he is a proud father of two daughters and is an avid recumbent cyclist.

Story editor:

Diane Guernsey

Comments   

# les cohen MD 2014-10-27 10:45
Beautifully done. Well written and spare when it needed to be. Congrats.
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# marianna crane 2014-10-24 17:36
I have cared for many patients like Ms Virginia. They either tell wonderful stories about how well things are going for them at home or delight the provider with colorful tales in order to avoid answering questions but one home visit puts their condition in clear perspective. Thanks for the reminder how important home visits can be.
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