The Day Lizeth Died
Lois is a patient in her forties. She doesn’t mince words, uses language you wouldn’t call “polite,” sometimes expects special treatment, and always calls me “Honey.” She has a number of chronic conditions, and we see quite a bit of her at the health care center.
One day Lois came in for routine follow-up for her diabetes. She also needed a flu vaccine, and after reviewing her chart, I noted that she hadn’t had a tetanus booster for ten years. When I suggested that the medical assistant give her one at this visit, she responded, “I don’t need no tetanus shot. I don’t know anybody with tetanus!”
I explained that you don’t get tetanus from other people, that it’s caused by a bacterium that’s found in soil and other places in the environment — that even small injuries to your skin can expose you to this serious disease. She shot back, “So you’re trying to tell me that everybody should get a tetanus shot every ten years?”
I nodded, and she demanded, “So when’s the last time you had a tetanus shot?”
I had just checked my own shot records at the hospital, as part of a routine medical staff credentialing review. I had to admit to Lois that it had been twelve years since my last tetanus shot. I was busted.
“Well,” she declared, “I’m not going to have a tetanus shot until you have one.” Then she added, “And I’m not going to believe you’ve had one unless I see it.” She chuckled, thinking she had me.
I left the room to track down the medical assistant and explain the situation. She met me back in the room and proceeded to administer first my shot and then Lois’s.
Needless to say, Lois and I have a less-than-typical patient-doctor relationship. She doesn’t let me get by with being the one who always sets the terms of our encounters. Sometimes that insistence pushes me in ways that require some discipline if I’m to maintain a sense of humor.
On this occasion, I responded to her challenge as a sign of something real in our relationship. I took her interest in my own shot records as a mark of her authentic engagement with me in a bond characterized by significant differences, yes, but also by significant mutuality.
Doug Eby, a family physician in Alaska, talks about “the tyranny of the one-on-one physician-patient encounter.” He identifies this typical model for patient care as about the worst context imaginable for building genuinely human relationships. The usual patient visit is a private encounter, behind closed doors, characterized by huge power differentials and little mutuality. One party is at least partially undressed, the other often clothed in the priestly garb of the profession. Their interaction is usually scripted, following a predictable pattern dictated by the doctor.
John McKnight (Asset-Based Community Development) says that “service systems can never be reformed so they will produce care. Care is the consenting commitment of citizens to one another. Care cannot be produced, privileged, managed, organized, administered or turned into a commodity. Care is the only thing a system cannot produce. Every institutional effort to replace the real thing is a counterfeit. “Care is, indeed, the manifestation of a community. The community is the site for the relationships of citizens. And it is at this site that the primary work of a caring society must occur. If that site is invaded, co-opted, overwhelmed, and dominated by service-producing institutions, then the work of the community will fail.”
Unquestionably, boundaries are important. Equally beyond question is the reality that Lois and I have significant differences, differences in formal education, income, status, gender, culture. But I find that if I want to care for Lois, I need to be prepared to minimize those things that threaten to keep us in separate realms and let myself engage with her as a fellow human being in a mutual quest for greater health.
The day after her visit, I called Lois to report the results of a lab test she’d had. She interrupted my report to ask, “How’s your arm, Honey?” When I told her it ached some, she gloated, “Well, mine’s just fine.”