I judge. Even though I’m not supposed to, even though I try my best to stop myself, I still judge. Fundamentally, I guess, I’m a creature of habit, caught up in an endless current of seemingly instinctive behaviors. As a first-year medical resident, I sometimes feel acutely aware of this in my dealings with patients.
I stand at the bedside of Sharon Weathers, an unassuming woman in her mid-thirties for whom I’ve been caring over the past few days. She was admitted with excruciating abdominal pain that has proven resistant to our attempts at pain management. Each morning, I visit her to ask, “How did you sleep? On a scale of one to ten, how would you rate your pain?” And each morning, I feel a pang of suspicion–near-certainty, actually–that her pain is mostly a calculated attempt to get us to give her ever-higher doses of morphine.
This morning, Sharon looks as if she just woke up, her tangled blonde hair falling haphazardly across her face. As she struggles to sit up, I’m struck by how incongruous the cheerful polka-dot hospital gown looks on her tough-looking physique.
Sharon looks strong; she has the aura of a battle-hardened gladiator. Through the years, she’s suffered pain–a lot of it. Her life story is replete with physical insults–auto accidents, broken bones, gallstones and pancreatitis. Her hospital records reveal many previous admissions for pain syndromes that, like this one, have defied control with the usual doses of narcotics.
I reflect that Sharon’s probably gone through dozens of doctors like me–each one a fleeting presence, a bit-part actor in the drama of her life. But my role is about to grow more important: I have some bad news to tell her.
“The weather is a bit better today,” I say, stalling for time. Even after all these years of training, I still feel awkward delivering bad news. I hate the thought that my face will be burned into people’s minds as the human image of their misfortunes.
“I need to ask you something,” I continue. “Have you ever used IV drugs and shared needles with other people?”
“Yes, actually. Quite frequently,” Sharon says calmly. Clearly she’s been asked this before.
Then an uncomfortable laugh escapes her. “I used to be quite the party girl back in the day, you know.”
Pause. “I’m afraid you have Hepatitis C,” I say. “The tests show that you most likely have a chronic infection.” Hepatitis C, a chronic viral infection transmitted through blood and body fluids, affects the liver. Although many lucky people escape damage, it can sometimes lead to extensive liver failure–even cancer.
An awkward silence follows. I watch Sharon’s face go through a spectrum of expressions, from surprise to comprehension.
“Oh…I must have gotten it back when I was doing those damn needles,” she says matter-of-factly of this latest episode in the medical plot of her life.
But now Sharon begins to look ill at ease. Her eyes race back and forth between the floor and a distant corner of the room.
In them, I see something I’d never expected.
“Could my son have gotten it from me?” she asks.
Her eyes beg me to say no.
I want to say, “Of course not! You couldn’t have infected the most important thing in your life.”
Instead, instinctively, my mouth goes all textbook on me.
“Well, Mrs. Weathers, mother-to-infant transmission of Hepatitis C has been documented in numerous studies. There is a small but discernible percentage of Hepatitis C-positive females who transmit the virus to the newborn. The risk of such ‘vertical transmission’ is difficult to accurately ascertain; it depends on the level of viral replication in the maternal blood during the perinatal period.”
There’s nothing like spouting a string of cold, barely intelligible facts to distance yourself from a painful, sticky situation.
A tear streaks down Sharon’s right cheek. It’s the first of many that soon soak her face. She and I don’t know whether her son has actually been infected; only a blood test can tell us that. But it’s clear that, for Sharon, the very thought brings crushing guilt. What has she done? What might she have done?
Over the next few minutes, I occasionally break the silence with short, quick phrases about the need to assess her liver function and do a GI follow-up.
At the door, a head pops into view.
“I want juice, Mommy!”
It’s Matthew, Sharon’s four-year-old son. Sporting a million-dollar grin, he hops and skips into the room.
In a split second, Sharon wipes away her tears and opens the juice box from her untouched breakfast tray–a seamless transition from patient to mother.
As I prepare to leave, she looks at me one last time, her eyes imploring me to take my words back.
But I step away, trying not to look at her. I have my own guilt to deal with.
As I’ve said, I judge. I’d found it easy to dismiss Sharon as a lost cause, with her colorful history and constant scheming to get opiates. I’d banished her to the corner of my mind reserved for hardened drug-users–those who, in writer Michael Ondaatje’s words, ride the “boat of morphine” on a sea of oblivion.
Today’s encounter has offered me a flash of insight. For me, Sharon has become more than just another morphine order. Now I see her as a mother pinned down by the vulnerabilities of parenthood–and haunted by the possibility of having harmed her own son.
Her plight reminds me of my own insecurities, day to day, as my wife and I raise our three-year-old daughter. Whatever our differences, I realize that at heart Sharon and I are alike in our desperate, naive yearning to shield our children from life’s painful realities.
Over the next few days, I see Sharon several more times. She treats me as a confidante, and I see her as a reminder of the error of my ways. I see how we two share a common burden of guilt–she towards her son, and I towards her.
On the day of her discharge, as we finish our final meeting, she says, “Thank you for being my doctor. Thank you for everything.”
“Thank you,” is all I can say.
I can’t bring myself to apologize to Sharon for having mentally appointed myself her judge and juror. Inwardly, though, I thank her for reminding me that she’s a living, breathing human being just like me–a person who’s far more than the sum of her medical problems.
And today, many months later, I continue to catch glimpses of Sharon in all of my patients.
About the author:
Currently a first-year internal medicine resident at Overlook Medical Center in Summit, NJ, Adnan was born and raised in Pakistan, where he attended medical school and worked as a general practitioner before immigrating to the US in 2009. Married in 2007, he says, “I have a beautiful three-year-old daughter around whom my life seems to revolve. My interest in English literature was sparked when I picked up the novel Jude the Obscure in high school. This led to a several-year-long journey during which I enjoyed the works of Dostoyevsky, Hardy, Wilde, Maugham and many others. I write to document my existence and the slice of time and space that surrounds it. I like to read my work from days past in order to catch a glimpse of the person I was at a particular moment. Writing lets me take time out from the daily grind and gives me a chance to step back and view myself as a human being in the larger picture of life.”