“We’re never so vulnerable than when we trust someone- but
paradoxically, if we cannot trust, neither can we find love or joy.”
She was in her sixties. I had followed her for the better part of a decade. Her primary care doctor had become frustrated by her frequent complaints of pain, fatigue, and depression. He had done every test that he could think of. When one of her immune system tests showed a minimal abnormality, he heaved a big sigh and sent her over.
When I was in practice, I saw many of these cases. A large percentage of the people who came to my office in moderate to severe distress had no physical findings and little in the way of abnormal lab tests. They looked well. It is a major issue for arthritis patients: they do not look sick and many times their physicians and their loved ones get tired of hearing their complaints. Cancer patients lose their hair and their appetite. Lung patients are short of breath. Patients with immune disease are just as ill, but no one can tell from looking at them. They are often shunned.
I listened to her. She had a tired voice, as if she had been forced to relate her story numerous times. This is a common finding when patients are not sure that the doctor believes them. There were no abnormalities on exam. More extensive testing of her immune system revealed a couple of additional mild deviations.
I can’t prove to you that you have one of the diseases that I treat. On the other hand, you have been everywhere else. I think it is worth a try to put you on mild immune suppressants.
She was relieved. Very willing to put up with an uncertain diagnosis and potentially harmful treatment if there was even a faint ray of hope.
“I have no life. I have not enjoyed a full day in years. My children and grandchildren avoid me. Give me the pills.”
I was a bit surprised and almost elated when she felt better. Over the years there were numerous relapses. There were times that it seemed to me that she felt more comfortable being needy and disabled than having a more, shall we say boring existence. But improved she was. Her contact with her family increased. She was able to make a little extra money with part-time work.
New symptoms of exhaustion came up. Again, her physician minimized her complaints. She insisted on more tests. This time a neurologic disease was found. She received appropriate therapy and improved.
I began to root for her. The spells of fatigue and unexplained pain continued, to a lesser degree. Although I never felt that the moment was right to ask, I had the feeling that I get when I see an adult who was damaged as a child.
We grew close. She trusted me and was grateful for someone who paid attention to her complaints. As she improved, we had more time for idle conversation, rather than listing her complaints. I realized that she was bright and articulate. That she had a kind soul. That she did her best.
After we had known each other for several years I saw her for a regular appointment. She looked serious and a bit disheveled when I walked in the exam room. She was always glad to see me, even in her worst moments.
What are you so happy about?
An even greater expression of gravity and unpleasantness.
“These have been the worst four weeks of my life.”
She meant it. I realized that I had made a mistake by kidding her. I secretly slapped myself in the wrist.
I am sorry. I always kid around with you. It was not the right time, was it?
Talk to me.
“I found out that my husband was molesting one of our granddaughters. For years.”
These were the moments when I was grateful that I was rarely behind on my schedule. She would get the time that she needed.
Is the child OK?
The significant resources that we have available these days had been mobilized. The child was doing well. Her parents had been counseled. The prognosis was good.
Except for you. I cannot imagine what you must feel like.
A long silence. Some tears.
“The police asked me to stay with him until they could gather more evidence. Not to let on to him that I knew what was going on.”
That is awful. How could they ask you to do that?
“I did, for a week. I left. But I have nowhere else to go now.”
He is not in jail?
“No. The abuse took place in two different cities. In one of the jurisdictions they don’t even want to prosecute him. In the other the DA is highly active. He’s sure that he will get a conviction.”
Tell me more about how you feel.
“Relieved. He’s so controlling; I had never realized how free I could be. Angry. Helpless. We have been together almost forty years. I have been ill. I cannot support myself. I have no home. It is a long time to live with a criminal. To make it worse, I was abused as a child. All of those memories have come back”
I understand what you’re saying. It is always the same with these jerks. They make the victim feel that they are the ones at fault. One of my patients told me that her husband shot at her if the food was not the right temperature. For years she felt that it was her fault when he pulled out the gun.
I let my words sink in for a minute.
It is not your fault that he’s a jerk. That he lied to you. That he kept you dependent on him for food and shelter, so that you felt reluctant to question his dominance. You were in the wrong place at the wrong time. So was your grandchild. Lightning hit you both.
If you leave here with nothing else, you must understand that this is not your fault.
“Why do I feel like it is? That I could have done something different?”
Because you are a nice person. He knew what he could get away with, because he has been doing this to many people all of his life. He is a master of deceit. He knows who he can fool. You are doing the best you can. NOT YOUR FAULT.
I stood up.
You need a hug.
She nodded again.
You will be OK. You are strong and smart. Today you deal with today; tomorrow will be taken care of when it gets here. Your children will be there for you. Your doctors have your health under control. He cannot hurt you anymore. You will do fine.
The first smile of the visit.
She stood up and opened the door. A bit more spunk in her step. Head held up high. Stronger than she knew that she was. Ready to live.