When I entered the exam room I found my patient, a woman in her 80s who’d come in for a routine visit, holding a photograph. “I need to show you something,” she said. Some patients bring me photos at every visit–usually their kids’ or grandkids’ annual school pictures, or smartphone shots of a wedding or christening–but she never had before. I wondered what it might be.

She laid the photo on the corner of my desk. In it, she appeared, a few years younger than she is now, with a handsome, middle aged man who resembled her. He might have been her son, except she’d never mentioned him before.

“This is my son,” she said.

I remained silent, waiting for her to share with me the painful fact that she’d had a son, and that he’d died.

But that wasn’t what she wanted to say. Not at all.

She went on to tell me that her son was severely disabled, and had lived for many years in a residential facility, and that she’d never told me about him before but wanted to do so now. It was clearly important to her that I know about him. And that I see him.

I am thinking of the many times I have been moved by a photograph shown to me by one of my patients. So often photographs seem to say what cannot be said, and bring evidence of lives lived beyond the narrow confines of my office.

There was the old woman, who’d reluctantly moved to a nursing home, too feeble to walk up Beacon Hill to the apartment in which she’d lived independently for decades. The first time I saw her after the move she pulled out an old leather wallet and handed me a sepia picture of herself as a WAC in World War II–young, beautiful, and tough as nails. Though I’d known her for years, she’d never shared this with me before. The picture told me what I could not see, and what she could not say: I have not always been this way, the way I am now.

Another woman handed me a photo album the first time I met her. She was a slender, fit-appearing woman, but the album featured a version of herself 100 lbs heavier. This is where I used to be. This is the place to which I fear returning.

Once, a patient’s photographs transformed my relationship with her. For years she’d been difficult to satisfy, coming in frequently with pain migrating literally from head to toe, for which I could find no explanation, and which I could not alleviate. One day–I’m not sure why–I asked if she saw her kids much. Without a word, she reached for her pocketbook, and showed me two baby pictures, their edges worn to fuzz as if they had been rubbed, over and over.

“These are my grandchildren!” she said, smiling broadly.

“They’re beautiful!” I said, grateful to have found a topic, other than pain, that animated her. “Do you see them often?”

She told me that, in fact, she hadn’t seen them in years. They were now teenagers. She was estranged from their mother because of an old argument, and all contact with her grandchildren had been forbidden.

No more needed to be said. I watched her stroke the edge of the photographs before putting them back in her purse, and my image of her was altered permanently.

Suzanne Koven is an internal medicine physician who blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50.