Bothersome Reaction

On Friday, as I spent time seeing patients with one of the Clinical Officers, I witnessed a patient interaction that was particularly bothersome. The Clinical Officer (CO) did not wrong, nor did the patient. But the more I have thought about the case the more bothered I have become.

The patient was a 28 female. She is divorced and has no children. She presented with several complaints. The CO ran several tests. One of the tests was for HIV. The young lady was positive.

I was interested to sit back and observe her reaction when she was told this news. As the CO reviewed her labs with her, I watched her face intently for her reaction to this serious news. Her reaction? NOTHING.

For at least 5 minutes as the CO went over the meaning of this result, her expression was unchanged. She didn't blink. Not a facial muscle moved or changed. There was no wrinkling of the forehead, narrowing of the eyelids, or quiver in the lip - it was if her facial nerves were paralyzed. And there was no change in her body language - there was no drooping of the shoulders, no head lowering, no averted gaze, no shifting in her seat. She was unchanged, stone cold motionless.

I was shocked. I wanted to yell out, "Don't you get what the CO is telling you?! You have HIV. You have a death sentence. This is serious." But I know she had to be feeling something on the inside. The only reaction she displayed was that her eyes moistened for just a moment when she told us that her husband left her 3 years ago for another woman. But even this display of emotion was brief.

Life here is difficult. Expectations continue to be unmet - I expected an expression of sorrow, of fear, of anger, of something. I was not ready to watch this woman respond with such outward stoicism. It almost seemed as if she was already dead.

Comments

[Bob Travis]

Hello Dr. Tim,
As an ex-combat Marine (I carried a B.A.R. in Korea), I can testify to her case. When I first arrived in the field, each pop whiz or explosion caused me to dive for cover, hide behind or under something, and at the same time fight to keep myself from soiling my pants. (Believe me, many men did just that.) After about two weeks or so of combat exposure, one develops the "thousand yard stare". The common civilian emotions diminish and one desensitizes and reacts only to very immediate danger. Often, a close call may only elicit a short laugh as one watches the smoke clear and waits to be able to hear again. Common is the desire to find and kill the one who tried to hurt you or your buddies.

This poor woman must have been facing a lot of continuous very tough times. Whether it be combat in the field of war or in the field of life, the only difference is in the noise and the violence of death or dismemberment. The fatigue of everything going wrong may be much the same.

I just can't tell you how much God became my best friend to talk with almost every minute of those days; and the talk was hardly ever about getting me out of the mess. I pray that this poor woman learns to do this and not blame Him for her problems. It really is the greatest balm for life's bruises. My sorrow for her also teaches me just how fortunate I am here at home. Your reaction shows me your compassion. God bless and help you Dr. Tim. You're a jewel! Bob

[Paula]

Tim, I would like to link to this tomorrow in my blog. Thank you for sharing this even though it's so sad. It's an awareness many of us don't get a picture of. Bob also offers insight and I appreciate this.