It was early November–the sky a sharp, deep blue that only comes at that time of year–and my primary-care clinic in the heart of the city was booked full with bronchitis and early flu. The TV in the corner was tuned to CNN. Children bounced around in boredom, chatting away in an assortment of languages–Haitian and Portuguese creole, Spanish, English.
My last patient of the morning was Jack, a man I’d been seeing for the past few years. He was a middle-aged guy–almost the same age as I was, in fact. I found him sitting quietly in the examining room, reading glasses on and newspaper in hand, wearing a jacket with his employer’s logo on the front.
Unlike most of the people in the waiting room, Jack was feeling well. He was only here to follow up on the usual suspects–diabetes, hypertension, cholesterol, weight struggles. When I checked his blood pressure, though, it was way out of control.
“That’s strange,” I said, looking through his records. “Your pressure is usually pretty good. Have you missed your medications at all in the last few days?”
“No. I take them every day. Might just be”–he took his glasses off and rubbed his eyes for a minute–“a lot of things going on.”
“Oh, you know. Working a lot…” He was a truck driver, and I knew that his schedule could be bad.
“…and then all this stuff with my boys.”
He said it as though I must already know about it. I glanced at my notes from his last visit, but saw no mention of any trouble with his sons.
“What happened to your boys?” I asked, starting to type my notes for the visit into the computer.
“Both in jail, that’s what happened.”
I stopped my typing in mid-sentence and turned to look at him.
He shook his head, as though he didn’t know where to begin. I was glad he was my last patient of the morning–running a little later than usual wouldn’t matter all that much.
“I’m sorry to hear that,” I said carefully. “Why are they in jail?”
“Well, the police say my boys killed somebody.”
He looked away from me. “I think they might have, too. I mean, I think one of them did. The other one, I’m not so sure…I think he’s just trying to cover for his brother.”
I was quiet for a stunned minute, trying to imagine how this could have happened, and how it might feel as a parent to learn something like this about your child. There are just so many things that can go wrong, even in a short life.
“I’m so sorry,” I said. “This must be so hard for all of you.”
“How are your sons holding up?”
He shrugged. “I don’t know. I haven’t talked to them.”
“I don’t think it’s a good idea–for me. I got my own health issues, and this could get very stressful. I got to take care of myself.”
Like my patient, I’m a parent. My children are younger than his sons, whom I remembered as being in their late teens or early twenties.
I’d assumed that he’d tried to see them but had been prevented. It took me a minute to understand that he’d made the decision not to be in touch.
He told me more. The murder had taken place more than two weeks ago, in a park not far from where my patient and his sons lived. The boys had been in custody for over a week, during which time my patient had made no effort to contact them.
Here was a moment in the patient-doctor interaction that fell far outside of any medical protocol.
On one hand, Jack was my patient, a man suffering tremendous stress. I grieved for him. On the other, he was a fellow parent who was (I thought) making a big mistake. Guilty or not, his sons needed their father more than ever. When I imagined them in jail and alone, I felt angry at him.
I don’t doubt he felt my surprise–and my disapproval.
“You’re not even going to call them?” I asked, trying hard to sound neutral.
He didn’t answer me directly, just went on. “Their mother says they got a lawyer and everything. I think this is just how they have to learn.”
It was like he was reciting a lesson. This was the story he was telling himself: It’s better for them.
I took a breath, and a minute, trying to calm my warring emotions. Then I forced myself to say something more generous than what I was actually feeling.
“I’m glad that you’re taking care of yourself. I hope your sons are okay.” Something like that.
My unspoken response ran more along these lines: You can’t mean that. What are you thinking? Go to them NOW.
I wonder if he sensed my restraint. I wonder if he heard what I didn’t say.
“Yeah. I hope they’ll be okay,” Jack answered. He looked down at the plastic bag he was carrying, then reached in and started to pull out medication bottles.
“I think I need a refill on this one,” he said, clearly wanting to change the subject. I took the bottle from him, and the cue, and moved on.
I scheduled an appointment to recheck his blood pressure the following week, then asked if he wanted to meet with a counselor to help him with what he and his family were going through.
“No. I don’t need that. I have people I can talk to.”
Just before Jack left, I checked his blood pressure again. It was almost as high as when he’d arrived.
“You know, I’m wondering,” I began. “About your blood pressure…”
The words were on the tip of my tongue: Maybe your blood pressure is so high because you’ve decided not to see your sons.
I stopped speaking, because I saw through myself. There might have been an iota of truth in that thought. But what I really wanted to say was that I wished he would change his mind and go to see his sons.
“What?” he said.
“Nothing. Never mind.” I walked with him toward the checkout desk, still feeling ambivalent, still uncertain about where caring ended and interfering began. Would I be taking better care of him by telling him what I really believed? In not sharing my reactions, was I being respectful–or just dishonest?
I still don’t know the answer to those questions.
“I’ll see you soon,” I told Jack as he left. “And I hope it all goes well.”
About the Author:
Kathy Crowley is a physician at Boston Medical Center and an associate professor of medicine at Boston University. She is a 2012 Massachusetts Cultural Council fellow, and her short stories have been published in literary magazines, nominated for a Pushcart Prize and shortlisted in Best American Short Stories. A founding member of the group writing blog Beyond the Margins, she lives outside of Boston with her husband, three children, assorted pets and lots of unfolded laundry.