Notes from a Healer

True Grit

Brian T. Maurer

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Two identical surnames appear back to back on my morning patient roster: a sister and brother, both scheduled for physical examinations.

She’s 17; he’s 15.  I haven’t seen either one for several years.  When economic times are hard, the family income only goes so far.  You cut corners where you can.  If the kids aren’t sick, why bring them to the doctor?

The 17-year-old has blossomed into a lovely young woman.  She’s a junior in high school this year.  When questioned, she admits that she is failing two subjects.  English is one of them.

“You need the English credit to graduate,” I say.  “I suppose you know that?”

She nods her head.  “I try and I try, but I just can’t seem to make any headway.”

She seems to be reasonably intelligent.  “What do you think the problem is?”

She shrugs her shoulders.  “Don’t know.  New school maybe.  We moved this past August.  It’s been a tough fall.”

I review the questionnaire on the back of the encounter form in her chart.  “I see that you’re having sex, but you don’t use contraception.  Aren’t you worried that you might get pregnant?”

“Yeah, I know—not a good situation.  My mom made me an appointment with her gynecologist, but we had to cancel at the last minute when my mom got sick again.  We’ve rescheduled—sometime next week.”

“So your mother’s aware that you’re sexually active?”

Again she nods her head.

I spend a few minutes reinforcing her need for birth control and talk about alternatives to the pill that she could consider in the meantime.

After the physical examination I recap our earlier discussion.  “See if you can get the English grade up, and be sure to keep that appointment with the gynecologist,” I tell her.

I step into the adjacent room where her brother waits.  He’s a scrawny 15-year-old with a face full of acne.  He has a ready smile for me.

“How are you doing?” I ask.

“Can’t complain.”

“Life is good?”

He laughs.  “Yeah, life is good.”

“You’re a freshman this year?  I understand you moved last summer.”

The smile fades from his lips.  “Yeah—but I’m getting along okay.”

“Still taking your medicine to help you with your studies?”

“Yeah.  It works pretty good.  I usually don’t take it on days when I’m not in school.”

“Do you notice a difference?”

“Maybe a little, but it’s not bad.”

“Your knee has been bothering you?”

“Yeah.  Sometimes my knee pops out for a few seconds—nothing serious.  My shoulder, too.”

We proceed with the examination.  The knee and shoulder appear to be stable.  I suggest some exercises to strengthen these joints.  “Do you have a set of weights?”

“My grandfather does.  He lives next door.  He’ll let me use them.”

We finish up, and I meet with the mother in another room to discuss my findings.

“It’s been a difficult year,” she tells me.  “I had to have bowel surgery.  I’ve got a colostomy now.  I keep getting these pockets of infection—abscesses—in my belly, which they have a hard time clearing up.  I have an infectious disease doctor as well as a surgeon and my regular doctor.  I’ve been in and out of the hospital for the past six months.”

“You look like you’ve lost weight.”

She nods her head.  “I lost 70 pounds.  I can only eat pureed food now.  At one point they thought I wasn’t going to make it, but I’m thinking positive now.  The new year’s here—things will be better in 2011.”

“I certainly hope so,” I say.

“I’ve got good kids and a supportive husband.  My family’s been there for me.”  Slowly, she rises from the chair, cradling her belly with one hand.  “All in all, I’m blessed,” she says with a warm smile.

The intestinal fortitude of such patients never ceases to amaze me: true grit—and in the midst of overwhelming suffering, sufficient grace.


About the Author

  • Photo of Brian T. MaurerBrian 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 patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice. Interested readers can read more of the author's writings at his website and blog.

  • Published: March 5, 2011