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Wednesday, April 18, 2012

Through a Different Lens - Với cái nhìn khác

Through a Different Lens
Becoming a mother herself changes one physician’s view of her patients.
By Lindsay Byrnes, M.D.

My patient is gone. I don’t know where. I fear she is dead or on the streets. The only thing I am sure of is how incredibly sad her life was when I knew her.

I met her on the pediatric ward, as she was barely in her teens. She had been transferred from the intensive care unit where she was recovering from postpartum sepsis and other complications. Days before, she had delivered a baby girl.

From the time of her arrival, her behavior was difficult. It went beyond adolescent insolence or the effect of illness. She screamed, cursed, and refused any medications or treatments the nurses offered. Rather than providing security and reassurance, my patient’s mother was often absent; when she was present, she was usually intoxicated. Strangely, she found antagonizing her daughter entertaining. When the room went silent, it usually signaled that they had gone downstairs to smoke together. None of us wanted to blame the girl, given the obvious lack of parenting and her medical condition, but dealing with her was trying. My disdain grew every day, with every interaction.

Sadly, she is only one of many teen mothers I have cared for during my residency. We know the societal impact of teen pregnancy, and we know that we have failed to find solutions to the problem. Having a child when one is still a child oneself is a problem. That cannot be denied. I have always had very strong feelings about this, as many of us do. I have met many young mothers in the nursery with their newborns and delivered my congratulations and encouragement through gritted teeth. I have felt frustration and pity, even anger toward these girls. I have blamed them for not taking responsibility for preventing the pregnancy, which I assumed was unwanted. Of course, I made assumptions without knowing the circumstances of the conception. In my mind, I justified my feelings by assuming that the baby’s life would be made unnecessarily difficult.

I have been thinking about these mothers a lot lately. You see, I am a new mother. And my perspective has changed.

Motherhood has been an inexplicable experience. I have felt misery, anxiety, exhilaration, fear, and so much love it seems my heart would break. I now understand that this occurs no matter your age. I can only imagine these feelings being amplified when one also has to worry about having enough food to eat or a home that is safe, or is experiencing any of the other stressors that are so often present in the lives of these young mothers. Tragically, my patient’s daughter died during the hospitalization. My patient didn’t cry. She didn’t speak. The cursing and yelling ceased. She left the hospital shortly afterward.

Certainly, the baby’s death saddened me at the time, but the girl’s loss is more visceral to me now. I wish I could speak to her again. I owe her more compassion than I expressed at the time. Surely she had the same dreams about her little one while she lay in bed at night feeling her kick. Surely she had the same tears well up in her eyes when she was given her baby to hold for the first time. As I sit in my warm nursery, I look at my healthy young son, and I cry for my patient, that young mother. MM
Lindsay Byrnes is an internal medicine/pediatrics resident at the University of Minnesota. She wrote this as part of an elective. She says: “It grew from my newfound perspective when I became a mother. I recalled an experience taking care of a teenaged mother who had lost her baby. I have always thought of myself as a compassionate person, and yet there were times during my residency when I lost my way with difficult patients. In writing this essay, I recognize an ugly part of myself. I hope that by writing, I will remember that compassion is the foremost responsibility of a physician.”

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