Scars

Morgan Alexander
Dayton, Ohio, USA

 

Taylor by Lauren Henschel. 2011. Part of the
Indelible documentary series.

“I see you’ve got some scars here,” the doctor said, gesturing to two faint, thin lines that ran down both sides of the patient’s neck. “What’s that about?”

The patient in the room with us was covered in scars across his neck and abdomen. Hesitantly, he confessed that the scars were remnants of surgeries needed to explore and repair a total of forty-two stab wounds he had suffered in his younger days. It was also obvious that his younger days were not something he wanted to discuss.

Both doctors quickly got down to business, confirming the inguinal hernia that had brought this man into our clinic. While their hands and eyes were moving over the patient’s abdomen, I took a moment to scan the rest of him. The off-handed question about surgical history had prompted shame, embarrassment, and defensiveness, which now shadowed his middle-aged features. It took no time at all for the physicians to come to their conclusion.

“You’ll need surgery to repair the hole in your abdominal wall. We’ll make three small incisions the size of a pen in your belly to fix it, you’ll get stitches in each of them and then over top there will be skin glue. You can shower the next day and in two to four weeks you’ll be feeling back to normal again. The scar tissue may make things a little tricky, but I’m confident we’ll be able to do the surgery successfully. Any questions?” Although I had heard this surgeon quickly repeat some version of this spiel many times, I was still not sure I actually processed any of it, even though I had been placing those stitches and that skin glue with my own two hands. I felt pretty sure most of the patients did not get the chance to process it either.

“I guess not.” We had been in the room for all of three minutes, in which time a surgery had been planned from beginning to end, and a look of unmistakable anguish had not left the man’s face. I hedged my bets that he did, in fact, have a few questions, and I knew for sure that I did. Are you okay? Are you nervous about another surgery? Is there a backpack full of shame weighing heavy on your shoulders? Are your scars any deeper than lines on your skin?

Cara by Lauren Henschel. 2015. Part of the Indelible
documentary series.

“Great, I’ll get you scheduled.” The attending briskly grabbed the scheduling form from its place on the wall while the resident turned to open the patient’s chart in search of abdominal CT scans. I looked back over at the patient to see tears quietly streaming from both eyes as he frantically pulled off his glasses to wipe them away. My heart leapt across the crowded little room toward him; I stopped myself just short of kneeling next to his chair to offer some semblance of comfort. Would a response from me emasculate him in front of these male doctors? Would it make him feel awkward?

I glanced back at the physicians standing within two feet of this weeping man, both with their backs to their patient, seemingly oblivious to him in their quest to operate soon and well. As a medical student, I do not get to set the tone. It is not my place to start translating the jargon that bubbles from the lips of medical professionals when patients ask questions; it might draw attention to the fact that doctors are not always explaining things well. It is not my role to finish a neurological exam with gentle questions about a patient’s crack cocaine addiction, even if it is the reason she suffered a devastating stroke at thirty-seven years old. It wastes the doctor’s time to dig up problems like that during rounds. It is not appropriate to offer a box of tissues to a man while tears stream down his face; this is not a place to shed or wipe tears, but a place to pick which mesh will best patch a peritoneal tear.

The attending finished filling out the scheduling form, asking a list of yes or no questions over his shoulder for his sniffling patient about blood thinners and comorbidities. The resident finished, nodding knowingly at the CT scans. They both turned around to face the still tearful man.

“It was great meeting you, Mr. Hart.” They took turns extending their hands for a handshake and passed him the paper that would be his admission ticket to operative hernia repair. “Check out is down the hall to your left – we’ll see you in a few weeks!” The patient nodded passively in reply and as they made their way out of the room, I was torn between total disbelief and heartbreak. How can you see scars no thicker than a strand of hair, but not that your patient is crying? How can you pick up on subtle radiographic densities, but not someone’s blatant sorrow? How can you know so much about how to repair the most fragile tissues in the human body, and nothing about how to ameliorate deeper pain?

Finally, I moved to reach for the box of Kleenex that lived next to wound care supplies in every room of the clinic. I handed it to him with a hand on his shoulder, desperately looking for the right words to take us beyond our many differences to a place of support and human connection. I was not even sure what had brought on the flood of emotion he was experiencing, but putting together the pieces, I had an idea.

Clifford by Lauren Henschel. 2013. Part of the
Indelible documentary series.

“Mr. Hart, you know that no one here is judging you, right? We ask about things that have happened a long time ago so that we can move forward with surgery in a way that will be best for you. But the person you are today is the person we’re trying to take care of, okay?” I watched as fresh tears rose and worried that I had stumbled over an emotional boundary I should not have. It would not be the first time.

He took a tissue and grabbed my hand with both of his, looking directly at me.

“I’m not that person anymore. I don’t want to be that person anymore or ever again.”

“I hear you.” I pointed to him. “This person is the person that matters.”

I sat the box of tissues back in their place between the sink and the menagerie of gauze, hearing just how cliché I sounded, but realizing just how much I mean it.

Mr. Hart wiped his eyes and settled his glasses back on the bridge of his nose.

He met my gaze and said softly, “Thank you. Thank you so much for saying that.”

We walked together to the check-out desk and I hurriedly wished him well, as both of the doctors I was working with walked into another patient room around the corner. What would go unseen and unheard and unsaid in that room? In the next?

The third year of medical school is designed to teach me a little bit about each specialty and guide my decision about which one to choose. What I have discovered is that my rotations are teaching me as much about what the medical field does not do as they are about what it does. Neurology teams identify and treat strokes but do not talk about the crack pipes that cause them. Surgeons look at their patients and see surgeries but not the person who lives inside the bodies they cut. I walk into a hospital every morning to learn how to see and do what most people cannot. Often, I walk out each evening worried that in doing so, I am forgetting how to see and do what most people can – to feel deeply, to explain simply, and to see the big picture amid the complicated and intricate brush strokes I am trained to hone in on.

I do not know which specialty I will choose, or how many more patients I will have to pretend not to notice while I wait for my turn to be the one who sets the tone. I do know that as I learn to become a medical doctor, I hope that I never forget how to look at a broken person and see something deeper than his scars.

 

 


 

MORGAN ALEXANDER is an M.D. student at Wright State University’s Boonshoft School of Medicine. Morgan aspires to practice psychiatry among underserved patient populations and hopes to do her part to make healthcare a more affirming experience. She serves on the executive board of Boonshoft PRIDE and her school’s chapters of the American Medical Women’s Association, Student National Medical Association, Medical Students for Choice, Refugee Student Alliance, and the Student Opioid Coalition. In addition to equitable healthcare, she values optimism, vulnerability, good coffee, and travel.

 

Winter 2019  |  Hektorama  |  Education