The Dark and the Light and the Hand Upon Your Knee

These past few days have been a whirlwind as time flies down here in Punta Gorda. I can’t believe I’m entering my last week of clinic work. I had a hard day on Thursday... I was seeing patients in the clinic and I’m not sure what came over me. A young mother had come to get her monthly birth control injection. Her presentation seemed routine; she denied any problems with the injection and admitted to having 4 children which was “plenty enough.” I was ready to sign her chart when I asked my famous last question; “is there anything else you want to talk about today?” She hesitated then pointed to her eye. She said it waters often and hurts now and again. I checked it with my light and didn’t notice any erythema or abrasion so my instinct was to think it was allergies. Again I asked my routine questions of “any recent injury or trauma?” She paused and then said she had been hit in the eye and wasn’t sure if that was the problem. I asked how she was hit and that is when our conversation about domestic violence began. I sat with the young mother for over an hour. She vented to me about the beatings she had received throughout her life. She said her husband drank a lot and would get angry at her when he would come home. She had a little boy sitting next to her who was about 6 years old. He had been playing in the corner during our interaction, but I had noticed early on that he had an intellectual disability. He didn’t speak well and his eyes were not rightly aligned. She said he was like that since birth. I asked if the children were ever in danger and she said no... until she admitted to a bat that had been used on the children before. Clearly she felt terrible and I didn’t want her to think that any of this was her fault or that I was judging her for putting herself and her children in that environment. Domestic violence is a situation that is a million times harder to escape than most people realize. So I tried my hardest to be a comforting figure that she could trust. One of the biggest steps in leaving an abusive partner is admitting they are abusive. So I was going to let her tell me all she could for as long as she could. Eventually I asked her if she was ready to report him. Not surprisingly, she said no. She told me that he was a big figure in the community and he would surely beat her if she were to say anything to him. I pleaded with her to consider intervention, but she quickly said it wasn’t “bad right now”... she avoided him all she could and said she was “safe” at the moment. I told her if anything changed or she ever felt in danger to come to us immediately. She nodded, but I hope she took the statement to heart. After all, statistics show that a women asks for help before leaving an abusive partner 7 times before she actually does. Well, one down. I gave her the injection and the medication for the eye and watched her walk out the door, toddler in hand and fear in her heart. I ran to the back of our clinic and started to cry. Maybe it was her situation or maybe it was the entire month of poverty I had been seeing building up in my tear ducts, but I couldn’t seem to stop the rain of sadness pouring out of me. In fact, maybe it wasn’t sadness but rather defeat that I couldn’t do more. I watched this women walk back to an abusive household knowing a drunk mans hand was waiting to meet her face. I held children with blistering rashes and treated patients with scabies and lice and then went home to a clean house and nice bed and fan driven air. The limit of my abilities finally burst out of my body in this moment and I felt 2 inches tall in a gigantic world full of despair. I wiped away my tears and finished seeing my patients, but the women’s eyes loitered in my heart. In the afternoon, I headed out on home health visits with Nurse Jenny. My head still felt full of depressive thoughts when I entered an elderly women’s home. I sat down next to her on her bed as she was hard of hearing. She placed her hand on my knee and lightly rubbed my knee cap. I listened to her lungs and heart; pulmonary edema. Not surprising considering she had severe CHF. I let my hands linger on her back as the touch seemed to relax her muscles. She leaned into me and I told her we were going to refill her medications etc. She smiled and patted my leg one more time before squeezing my hand. As I climbed into the van with Nurse Jenny I felt just a tad lighter. After all, home health visits bring me back to the reason I entered medicine; my mother (Ironically whose name is also Jenny). As a child, I went to the homes of my mothers patients and spent time with the children she took care of. I knew I loved health care from that day forward. Although there is SO MUCH left to be done in this world, there is also significance in every act of care. The medical failures and heart ache of poverty weigh me down, but the smile of a patient or the cure of an illness take off pound by pound. The bottom line is this; there is ALWAYS more to be done for the world, but every bit that you do matters. I recently said “you can only do so much” in reference to my experience in Guatemala. Well, I have decided to denounce that phrase. You can always do more and be more and try harder and be better. Life is an educational experience that NEVER stops. I could have counseled my domestic violence patient better and I knew it. I rightfully felt defeated. But by acknowledging your failures and short comings you open the door to learning and improvement. If I had simply said to myself “well there’s only so much I can do,” I would be no more prepared for my next case of domestic violence than I was that day. But now I feel motivated and empowered to try harder and find the resources that make a difference for those patients. There is ALWAYS more to be done for the world, but never let that smother all you are doing. Feel the weight of the world fully and deeply, but also feel the release when you make an impact, no matter how small. I am glad I am an emotional practitioner. I want to feel hurt for my patients and joy for their recoveries. In fact, I think it is a piece of me I am starting to embrace. After all, how are you supposed to feel happiness without first experiencing hardships? Seeing the darkness in the women at the clinic made me realize all the light in the hand upon my knee. There is not “only so much you can do” for people but rather as much as you can do to one day do even more.