Pamela sits on the examining-room stool, looking at me expectantly.
I am in my first year of medical school. I do as I've been told to do in Medical Skills class: I observe my patient--without judgment or assumptions--and try to figure out what questions to ask, based on the information I am given.
Pamela has curly, strawberry-blonde hair and looks to be thirty, just a few years older than me. Her infant son lies in a carrier beside her.
Dr. Clark, whom I'm shadowing, has just given Pamela osteopathic manipulative therapy for her chronic headaches. Now the doctor is treating Pamela's older son, age seven, for back pain; he fell off the school jungle gym a few days ago.
All three patients--mother, son and infant--are wearing red: a red tank-top on the mom, a red t-shirt for the son and a red blanket for the baby.
Dr. Clark's eyes are closed. Her hands rest on either side of the boy's head. He squirms, and she gently resists the motion and calms him.
Pamela looks to me for an explanation. I know that Dr. Clark is trying to feel for the primary respiratory mechanism--a pulsation of cerebrospinal fluid that's independent of the pulse or breathing rate--but I don't feel capable of explaining it. I don't fully understand it myself.
Feeling at a loss, I look down at the baby. Giant blue-gray eyes blink up at me through pale brown hair and huge rosy cheeks; his mouth is agape, with a tiny tooth trying to come in.
"Your baby is adorable," I say, because I usually don't know what else to say about babies.
"Thank you. His name is Joe."
"You know, his daddy and I aren't married. We don't live together," Pamela offers. "He's a doctor, in psychiatry. The other day, it was his turn to have the baby, and he called me. Joe was crying, and his daddy had no idea what to do. I warned him that being a parent has nothing to do with being a doctor."
I smile, feigning understanding, and nod, trying to imply, Doctors, they think they know everything! I'm also trying not to look surprised by what Pamela's just said, but I think my eyebrows give me away. My subconscious assumption about her was "mother of two, with a partner." Clearly I was mistaken.
Pamela looks confused. In a misguided Medical Skills move, I try to fill the space with questions.
"Joe is his first child?" I ask, hoping that this isn't too intrusive.
Pamela looks at me a bit suspiciously, then answers, "His first child? Yes. But..."
She takes a breath, and continues. "Two months after I had him"--she points to Joe--"I found out that his dad had another baby on the side. We were engaged and everything, and here he has another child with another woman."
I make a sympathetic face, but inwardly I'm floundering. All I've learned so far in Medical Skills is to say "I'm so sorry" when someone has died. I know that I'm not supposed to say "I understand," because the patient's experience is not mine--and in this case, I really don't understand.
Instead I try, "That's terrible." I let out a nervous laugh and shake my head, this time trying to convey, Men--aren't they horrible?
Again, Pamela looks confused--and now I'm confused, too. I'm scared to ask more questions, in case I offend her or elicit other unexpected answers. In my head, though, I have so many questions. How can she talk about this so matter-of-factly? I know how I'd feel if my fiancé cheated on me....
"Joe looks just like him," she says. "But his other baby...." She rolls her eyes. "I've seen her. She looks nothing like him, and I'm like, 'You should get a paternity test.' "
Again, I smile and nod. I don't even know anymore what I''m trying to convey.
I look at the baby again.
"Hi," I say to him in an airy voice. "Hi hi hi hi hi!" I put my hands over my eyes, then uncover them, trying to start a game of peekaboo.
The baby looks away.
Pamela and I look at her other son, lying on the table. Dr. Clark's eyes are still closed--either in concentration, or to convey that I'm on my own.
I look back at the baby.
He starts to fuss.
"Do you want kids?" Pamela asks, picking him up.
I could just say no, I think. She's been truthful with me; wouldn't it be courteous to be truthful with her? But I want to find common ground between us.
"Yes!" I lie. I'm in no place for kids right now, but how can I say that to her?
"That's a good," she says, putting the baby back into the carrier. "I didn't want kids, and I sure didn't have time for them. I waited until I got my doctorate before having my first." She nods towards the seven-year-old.
I smile and nod. It's now just a nervous tic to hide my reactions. Still, I feel myself relax a bit. She's a "professional," and for whatever reason, I can relate to that.
Dr. Clark pushes back from the treatment table, finished. Pamela's older son hops off the table, looking disoriented and drowsy, but clearly pain-free and excited for the next adventure of the day.
Pamela thanks the doctor, thanks me.
We shake hands. Still feeling at a loss, I say again, "Your baby is adorable."
Pamela smiles, nods. "Good luck," she says, then is gone.
As she walks out, I realize that I still know almost nothing about her. I barely asked any questions, and once I got an answer I felt comfortable with, I stopped asking. I assumed that because she has a degree, she must also have a job and be able to support herself and her children. That may be true; I don't know, and wouldn't know unless I asked. I definitely didn't ask.
I hope that Pamela and her children are doing well, are happy at home and have support--but I'll never know, because I felt afraid to ask the questions that might have revealed a different, less welcome family portrait.
This business of interviewing people--of putting them at ease and being at ease myself, of asking questions and then doing something with the information given--is hard.
I am trying.
About the author:
Annie Whetzel is an osteopathic medical student at the Portland, Oregon, campus of A.T. Still University. Writing, yoga and biking are her havens of relaxation amid the stress of school. "As a student, I know that every patient encounter is a learning opportunity. When I reflect on one that was awkward and made me uncomfortable, or on one that went well, it gives me a chance to relive those situations and to understand where things went smoothly, and why, or where I derailed the conversation, and why."