Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Much of the human spirit lies outside a physician’s power

Deborah Pierce, MD
Physician
September 22, 2015
Share
Tweet
Share

I first met Marie five years ago. A petite, soft-spoken woman in her thirties, she was the patient of one of the residents whom I supervise at our community hospital. Marie worked in housekeeping for a large corporation; she and her husband, a bus driver, had a six-year-old son. Now she was twenty-six weeks (six months) pregnant with their second child.

Marie’s blood pressure was markedly elevated (168/120), she had fairly high amounts of protein in her urine, and her baby measured small on the ultrasound. These pointed to severe preeclampsia — a serious complication that can quickly worsen, leading to kidney damage, seizures or even death for mother and child, and that can only be cured by delivering the baby.

The resident and I reached a swift, unanimous decision: Marie’s pregnancy was far too high-risk for our hospital. She needed to be transferred to the University Hospital across town — “the U,” as it’s known. And the baby would need to be delivered soon.

But Marie had other plans.

“No,” she said quietly and calmly. “I’m not going there.”

We listened as she spelled out her concerns: the costs involved, the need to find care for her son, the time lost from her job.

“And I have no insurance,” she finished.

We offered solutions — including reassurance that, once admitted to the U, she would quickly get insurance approval. Again, we underscored our concern about the health risks she and her baby were facing.

“I know you’re saying that I could die, and my baby could die,” she replied, quietly but firmly. “We’ll be OK, and I’m not going to the U.”

Fleetingly, I wondered if the real reason for her refusal was a fear that, once the U doctors saw her, they’d insist on a C-section. This was indeed a strong possibility — and to my mind, it was preferable to risking both her life and the baby’s. Still, I didn’t feel comfortable trying to force her to go. If this turned into a battle of wills, she might refuse to come back at all.

The best we could do was to persuade Marie to accept a referral to the U’s outpatient high-risk clinic and get her an appointment there for the following day.

Unhappily, I sat down to write a supplemental note in her chart, fearful that she might suffer a seizure, stroke or worse overnight and that our colleagues would condemn us for not forcing her to go to the U immediately, or at least admitting her to our hospital for monitoring. Keenly aware that I was choosing my words with an eye towards the lawyers and peer reviewers, I hoped fervently that Marie would keep her appointment.

The following day, though, her electronic record showed no clinic visit, so I asked our nurse to contact her and see if she needed help getting to her appointment.

Marie told the nurse that she was fine, and that she’d see us the following week at her regular appointment.

ADVERTISEMENT

At ensuing visits, the same scenario played out over and over. Despite the hypertension medications we’d prescribed, Marie’s blood pressure stayed high (160/110). The resident and one or another of my fellow attendings would sit with her, point out her continued preeclampsia and the baby’s slow growth, and try to cajole her into going to the high-risk service.

Week after week, she calmly refused: “We’ll be OK.” Week after week, my colleagues and I exchanged anxious emails.

I happened to be on call in the labor triage unit when Marie, now thirty-two weeks pregnant, came in complaining of a mild headache.

Seeing her exam results, I felt a stab of alarm. Her blood pressure was still soaring, and her labs were worse; now she had elevated liver enzymes to go with her high urine protein.

“Marie,” I said, surprised at how sharp I sounded. “It’s time. Your numbers are worse, and your headache is a sign that you’re getting even sicker. I’ve called an ambulance, and you must go to the U today.”

Marie gazed at me enigmatically.

“How about tomorrow?” she asked. “Or can I take the bus?”

“No,” I said firmly, feeling like a bully. “You need to go now — and you need to take the ambulance.” I had her sign a consent form, and soon after, the ambulance raced her to the U.

My relief was tempered by no small feeling of shame that I’d forced her to go — and fear of the damage that her preeclampsia might have wreaked on her baby’s health and her own.

Shortly thereafter, I heard that Marie’s baby, whom she named Emmy, had been born right after their arrival. Although Emmy was vigorous, she was also very small, and she suffered from multiple health problems. She’d been put on a ventilator and a feeding tube; she had a heart murmur; there were concerns about her vision.

Slightly reassured to hear that Marie had expressed happiness over her successful delivery, I still felt guilty about bullying her and puzzled about her reluctance to go to the U; I felt that I’d missed an opportunity to address that issue with her.

Baby Emmy’s doctors sent many reports and consult letters in the weeks to come, and her chart overflowed with their notes and acronyms. After finally being discharged home, she was soon readmitted for an abdominal tumor. Mercifully, it was benign — but it added surgeries and more consultants to her medical saga.

Over the next few years, Emmy continued her leisurely growth. Gradually the specialists all signed off on her care, leaving their entries in her records as mementos, along with the surgical scars on her abdomen and chest wall.

This past fall, not having seen Emmy for a couple of years, I spotted her name on my schedule. She was coming in for a well-child check.

I wonder how she’s doing? I thought, remembering her rocky start.

Entering the room, I saw a happy, verbal, five-year-old little girl.

“I’m going to go to school!” Emmy exclaimed as Marie looked on, smiling proudly. “I’m going to ride the bus with my brother. I’m going to go to school for a long time, because I want to be a doctor, or maybe build things. And I want to get a cat — but my brother is allergic.”

While examining her, I said, “I have a cat who has a scar on his belly, sort of like this one on yours.” The exam confirmed what already seemed clear: Emmy was now a thoroughly healthy child.

Afterwards, she looked at me.

“Here, this is for you,” she said, handing me a drawing that she’d scrawled on the back of her registration paperwork. It showed her family, with a cat.

I thanked her, said goodbye — and barely made it out of the room before happy tears started streaming down my face.

Emmy’s small, hand-drawn picture showed me the bigger picture: That for all the times things go badly despite our best efforts, sometimes things go well even when our patients, for whatever reason, don’t accept the care we want to give.

Our ever-advancing medical knowledge notwithstanding, so much of the human spirit and of human health lies beyond our knowledge, and outside of our power.

Emmy’s picture remains on my wall to remind me of this.

Deborah Pierce is a family physician. This piece was originally published in Pulse — voices from the heart of medicine. 

Image credit: Shutterstock.com

Prev

3 things Walter White can teach doctors

September 22, 2015 Kevin 3
…
Next

The human physician will soon become history. Here's why.

September 22, 2015 Kevin 16
…

Tagged as: OB/GYN, Pediatrics

Post navigation

< Previous Post
3 things Walter White can teach doctors
Next Post >
The human physician will soon become history. Here's why.

ADVERTISEMENT

More by Deborah Pierce, MD

  • a desk with keyboard and ipad with the kevinmd logo

    When concierge care is reserved for pets

    Deborah Pierce, MD

Related Posts

  • A physician’s addiction to social media

    Amanda Xi, MD
  • This patient interaction is a reminder of the power of being human

    Johnathan Yao, MD, MPH
  • Think deeply about ways you can use your power as a physician to make change

    Danielle Plattenburg Arnold, MD
  • How a physician keynote can highlight your conference

    Kevin Pho, MD
  • Chasing numbers contributes to physician burnout

    DrizzleMD
  • The black physician’s burden

    Naomi Tweyo Nkinsi

More in Physician

  • Life’s detours may be blessings in disguise

    Osmund Agbo, MD
  • Inside the heart of internal medicine: Why we stay

    Ryan Nadelson, MD
  • The quiet grief behind hospital walls

    Aaron Grubner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to advance workforce development through research mentorship and evidence-based management

    Olumuyiwa Bamgbade, MD
  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Civil discourse as a leadership competency: the case for curiosity in medicine

    All Levels Leadership
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Life’s detours may be blessings in disguise

      Osmund Agbo, MD | Physician
    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...