Sometimes the challenge is too difficult. Sometimes there is less than nothing a physician can do to help his or her patient. Sometimes it is best to hoist the white flag and walk off the field. One morning in clinic several years ago brought this truth home with a hammer.
It was a Wednesday morning in April. Spring was two weeks old, but you would not know it if you looked outside. Rain, morning fog, a chill wind off the bay. I drove into Vallejo the back way that morning, on Lake Herman Road, sipping my French Roast, gearing up for the day.
Arriving at work, I scanned my schedule to see what lay in store. My first patient, Gloria Marquez, was coming in with what the scheduling staff had entered as “stress.” Great, I thought, I love dealing with stress. That’s why I did seven years of professional training after college. Right up my alley. I looked at my next appointment — Marjorie Statler, also coming in with “stress.” Oh, brother. This day did not look as if it would have an auspicious start.
Looking down the list, I saw “hospital follow-up,” “diabetes,” “stroke,” “weight loss.” Now these were chief complaints I could sink my teeth into, internal medicine issues that I might even be able to help with. But “stress”? Why has society medicalized “stress”? When people were stressed, why didn’t they talk to a friend, or their minister, or their coworkers? Why did people feel they needed to see an internist when they were stressed out? And if they must see a physician, why not a surgeon? Why can’t patients calling in with “stress” be directed to see a dermatologist? Who decided “stress” is the province of internal medicine? I wanted to talk to that person and introduce a little stress into his or her life.
Oh well, I thought, no use stressing myself out about it. I went out front to make sure a fresh pot of Peet’s was brewing, returned to my office and looked at the unread pile of journals collecting dust in the corner, vowing I would start reading them that night.
My 8:30 patient, Ms. Marquez, was put in the exam room and I went in to see her. She was sobbing when I walked through the door, eyes puffy and red, a large box of tissues clutched in one hand. Ms. Marquez was in her late 40s, had hypertension and borderline diabetes, but really did not come in very often. I saw on her chart that her BP was 170/110.
It took a minute for her to compose herself enough to respond to my asking her what was wrong. “My boy was killed two nights ago. Murdered. I still can’t believe it. He was 17 years old. He was going to go to Sac State in the fall.”
My heart melted. No amount of professional distance-keeping could prevent me from empathizing with Ms. Marquez. I could barely imagine what her pain was like. I asked her how it happened, and she told me the gory details — some sort of misunderstanding in a gas station over an issue of no consequence.
I asked if they had caught the killer, and she said yes, he was in jail, and she hoped he rotted in hell. He was an 18-year-old who had been in trouble with the law before. She knew the kid and his family.
We talked for 10 minutes or so, and the ventilating seemed to help. I told her I thought it was terrible how some kids acted these days, and that it was good they had already caught the guy so he could be dealt with appropriately. I gave her a note to be off work a week, a tranquilizer prescription, and the number for Psychiatry.
I returned to my office to document the visit, then went back to the front of the clinic to refill my coffee cup. Ms. Marquez was just leaving her room, and the medical assistant was bringing Ms. Statler down the hall. As soon as the two women saw each other, they both stopped abruptly. The tension level in that hallway went from 0 to 60 in about 2.4 seconds. I had heard the term “glaring darts” before, but this was the first time I had actually seen projectiles emanating from the eyes, and they were flying fast and furious.
I did not have time to think through what I did next. By reflex, I took Ms. Marquez’s arm and led her around to another exit hallway.
“That is the murderer’s mother!” said Ms. Marquez. “Her boy killed my boy. In cold blood.”
I apologized profusely, ushered Ms. Marquez out into the waiting room, and encouraged her to call Psychiatry soon. Whew, I thought, that was a close one. What twisted alignment of the stars had placed these two women in adjacent appointments in my clinic?
I then went in to see Ms. Statler, unsure what would happen. She was sobbing. Her eyes were red and puffy. She was clutching a box of tissues. It took a minute for her to compose herself to my respond to my asking her what was wrong. Ms. Statler was in her early 50s, had hyperlipidemia, and hypertension. Her BP was 170/110.
“My son was just arrested for murder. My 18-year-old boy. He didn’t do it, though. I know my boy. He would never do something like that. And that woman in the hallway has no right to blame me.”
I asked her to explain the details, and she said her son was jumped in a gas station two nights before. His friends helped defend him, and somehow one of the attackers was shot. Everyone ran off but her son, she said, and he was the one arrested for the murder.
My brain was on sensory overload at this point. There was no way I was going to sort this one out, nor should I even try. I was a physician, not a lawyer nor a cop. I listened to Ms. Statler talk for 10 minutes or so, then I gave her a prescription for the same tranquilizer I had given Ms. Marquez, a note for a week off work, and the phone number for Psychiatry.
I escaped back to my office and closed the door for a few minutes. I didn’t care if it meant I would run behind the rest of the morning. I needed a break. I thought about how awful life could be for the mothers of Vallejo. The sadness, loss, despair, embarrassment, shame. How did mothers cope when their flesh and blood got entangled in tragedies like this?
One thing these two mothers did was turn to their physician for help. But what could I offer? A little empathy. Some tranquilizers. A work note. These were flimsy bandages. They could not possibly cover the open wounds, the festering sores, that were wrenching the lives of Gloria Marquez and Marjorie Statler.
(February 2001)