The relationship between resident physicians and clinic patients is tenuous at best. Inner city minority patients rarely trust a predominantly white health care system. Poor folk have social and emotional problems beyond the capacity of clinic social workers to solve. In turn, residents view many of the patients as non-compliant, difficult and sometimes just stupid, even though they were often just doing the best they could.
But we should not be so quick to judge.
Jennifer was single and pregnant, living in a small town about 30 miles from where I was doing my residency. We first met when she came to the hospital at 27 weeks with what appeared to be premature labor. We got her uterus to settle down with injections of terbutaline, a medication which often prevents contractions but gives one wicked tremors and a fast heart beat. We don’t use it much anymore because of the side effects and it really doesn’t do anything for actual premature labor.
I discharged her after a few days with a prescription for terbutaline tablet and saw her in the clinic every week. She didn’t like how the medication made her feel and threatened to quit taking it. I told her the baby would likely have lung problems if delivered early, but I promised she could stop once she got to 36 weeks. She reluctantly agreed, but complained about the side effects every time.
Over the next several weeks I started seeing her as a lonely, frightened young woman instead of a difficult patient. She had social services looking after her in the clinic and her mother supporting her at home, but it wasn’t the same as having the father of your baby taking care you.
She stopped taking the terbutaline at 36 weeks, but her due date then came and went without labor starting. Now she was irritable and wanted me to induce her labor. Back then we waited until women were at least two weeks past their due dates before intervening; that did not make her very happy. But finally, she delivered a healthy baby boy. I hugged her when we were finished and when she went home.
I saw her in the clinic a few weeks later with abdominal pain; she’d developed an infection in her uterus. She cried when I said she’d have to stay in the hospital for a few days of IV antibiotics. This on top of a newborn baby at home was just another kick when she was already down. I promised I’d make her body feel better, but my heart ached knowing I couldn’t make her life better. Her infection resolved and she returned home. I finished my residency and moved on to a different world.
Twenty years later spent the summer working at the hospital and clinic in the town where Jennifer had lived. One day my nurse said, “There is someone in the waiting room asking if she can see you.” She had heard my name in town and wondered if I was the same person who’d taken care of her. I immediately recognized her last name and went to meet her with a mix of excitement and trepidation.
Jennifer looked like the same woman I remembered as a resident. We hugged each other tightly like old friends. She said she was doing well, still single but much more settled. She pulled a photo out of her pocketbook and handed it to me, saying, “I want to show you a picture of my son.” Her “baby boy” was now a six-foot-tall Marine and she was justifiably proud of him. I hope she was as proud of her own accomplishment as I was of her.
There is always hope if one has a little faith and a lot of love.
Photo credit: Can Stock Photo