The Yale Journal for Humanities in Medicine

Notes from a Healer

Initial Shock

The boy, now fourteen, has come in for a routine physical examination, accompanied by his grandmother. The old woman, a slender graying little slip of a thing, assumed guardianship of the boy when her daughter—the boy’s mother—died six years ago. I never learned the exact cause of her death—funny how we clinicians always focus on the event that marks a patient’s passing—but I do remember her face. After all, here it is again in the form of an old woman, regarding me from the chair across the room.

“What grade are you in this year?” I ask the boy. “How is school going?”

“Much better,” he says, and his grandmother nods her approval. “I’ve been keeping up with my work and studying hard. I want to make my grandma proud of me.”

“He certainly seems to have buckled down,” his grandmother says. “Not like last year….” She rolls her eyes.

“I’m going to try out for the basketball team,” the boy says.

“Did you play last year?”

“No, my grades weren’t good enough. But this year I have a shot at it, so I’m going to give it a go.”

I watch the boy’s face as he speaks, conscious of his wall-eyed appearance. I glance down at the chart to check how well he performed on today’s visual acuity test. Surprisingly, he demonstrates acceptable vision in each eye. I flip back through the medical record, searching for previous consultation letters from his ophthalmologist.

“His eye doctor says that he may need another round of surgery, but he wants to wait another year,” the grandmother informs me.

“Yes,” I muse, scanning the latest consultation letter. The words blur before my eyes, and in their place suddenly I see the eyes of the boy’s mother, unresponsive eyes beneath flickering lids as she stands before me years ago in this same examination room. “There she goes again,” the grandmother’s voice drifts quietly from across the room, “another one of those hysterical seizures!”

“Hysterical?” I query, as I take a step toward the ghost to prevent her from falling, “How so, hysterical?”

“They stem from the rape,” the grandmother’s voice informs me. “No one can tell when they might come on; they just happen.”

I blink my eyes back into focus, finish skimming the letter, and let the pages fall back into place, burying this ghost from the past.

“Well, let’s look you over today,” I say with a forced smile, and proceed with the boy’s examination.

He appears healthy, albeit slender and slight like his mother and grandmother before him. I step back to review my findings and offer a word of reassurance and encouragement. The boy smiles; the grandmother is pleased.

“One more thing,” I say, “you’re due for your chickenpox booster today.”

“A shot?” The boy suddenly sits up straight.

“It’s just a little pinch,” the grandmother says. “You’ll do fine.”

I step out of the room and return momentarily with the syringe and alcohol wipe on a tray. I explain the rationale for giving the booster and pass the vaccine information sheet to the grandmother. “Now then,” I begin, handing her the vaccination record from the boy’s chart and a pen, “if I could just have your initials right here for permission…”

“Oh.” A small short sound escapes from the grandmother’s throat; the pen trembles in her hand. I look and see that I have asked her to record her initials immediately below those of her daughter—now long dead—where she had signed years ago for the boy’s first shot.

“What’s the matter, grandma?” the boy’s voice breaks from across the room.

The old woman catches herself; I draw a short deep breath. “Nothing; nothing at all,” she murmurs. Quietly she records the two letters, her first and last initials, below those of her deceased daughter and hands me the pen.

“Remember, it’s just a quick little pinch,” she says to her grandson. “You’ll hardly know it’s there. Just don’t think about it—and you’ll do fine.”

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades. As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine. Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care. His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: December 1, 2007