This piece won honorable mention in the 2020 Hope Babette Tang Essay Contest, sponsored by the Gold Foundation and the Journal Academic Medicine. Medical students submitted more than 300 essays.
Dr. Sunshine was about to see the last patient of the day and hesitated before we knocked on the door. “Let me ask the patient first,” she said. It wasn’t unusual for patients to decline our request to examine and speak with them. This was OBGYN after all. But the patient consented, so I followed Dr. Sunshine into the exam room and stood out of the way, behind Dr. Sunshine on her wheeled, black stool.
From the exam table, the patient told her story. Told us of the years of sexual abuse as a child. The repeated rapes; the genital mutilation. The tears stretching from vulva to anus. She spoke of the scars, physical and emotional. How now, years later, her marriage has never really been what it could be; the distance now between herself and her husband. Her own lack of confidence, her shame, her self-hatred. Her tone was flat. She did not cry.
As I listened, I imagined the way she must roll over away from her husband in bed. The way she must shrug his hand from her shoulder. I imagined her squinting her eyes closed and grabbing handfuls of bedding beneath her trying to make the memories go away as she made love to her husband. I quickly blinked away my own tears.
Dr. Sunshine sat and listened without interruption. She just watched closely and heard the woman in front of us share her vulnerabilities.
Finally, the patient ended her story with a question. “Is there anything you can do?” she asked. “To make it look normal?”
The patient had come to Dr. Sunshine to be evaluated for reconstructive surgery. Dr. Sunshine’s eyes never left the patient as she nodded understanding, and asked if she could first do an exam. Carefully and gently, saying out loud her every movement, Dr. Sunshine examined the woman. “My hand is on your upper thigh now. I’m going to touch your labia. I’m going to touch your vulva next. Is there any pain? Here? What about here? Are you comfortable?”
The patient began to relax. I watched her jaw unclench and her knees lower to either side. Dr. Sunshine gestured for me to step closer, so I could better see her examine the patient. She moved slowly allowing the patient time to adjust to the exam. She spoke so reassuringly, moved so gently, that the patient didn’t mind my close observation. Though I imagined her own eyes saw disgusting scars and her mind was overwhelmed by horrific memories, the patient’s body had in fact healed with little trace of the torture it had endured. Like a person with anorexia sees huge thighs and grasps what feel like enormous handfuls of flesh from her bony hips, this woman saw a deformity, a twisted, discolored labia and a deformed vulva. Dr. Sunshine finished her physical exam and I helped the patient sit up.
Dr. Sunshine again sat across from the patient on her stool, hands folded in her lap. “You have healed well,” she said earnestly. “I can barely see where the tears were. There are some very small adhesions from scar tissue. These may contribute to pain during sex, but can possibly be removed with surgery. But truly the area looks remarkably, well, normal.” As she spoke, the patient’s shoulders relaxed downward; her demeanor changed. It was as if she was entering savasana, yoga’s final pose of complete and total relaxation. Earlier, she had told her story as a practiced speech like a school book report, remarkably devoid of emotion. Now her mask of indifference disintegrated; she still did not cry, but I think for the first time in a long time she allowed herself to feel again, and to maybe even hope that things would get better. The doctor’s words had negated her worst fears—that she was somehow ugly and unfixable. Dr. Sunshine asked if she had more questions, and she shook her head. As we left the room to allow her to dress, she said in almost a whisper, “thank you.”
“What did you observe on the physical exam?” Dr. Sunshine asked as we entered her office.
“It looked normal. I could barely see those adhesions you mentioned.” Dr. Sunshine nodded.
“What would you recommend?” I felt important that she was asking my opinion, but hesitated; this was not a straightforward case.
“Well, she seems pretty uncomfortable with how she looks,” I paused. “I think reassurance and talk therapy are really what would help the underlying problem.”
Dr. Sunshine smiled. “It’s important to hear exactly what the patient is saying. Sometimes it’s not about scar tissue or heavy bleeding. It’s about how the patient feels.”
I am not sure if this patient later had surgery. What I am sure of is how much I learned from this encounter. Like many experiences in medical school, this taught me much more than how to do a physical exam or what questions to ask a patient. I felt the horror of what this patient had endured and matured in my own witness of inhumanity. I was astounded at her resiliency. I was humbled by her allowing me in the room, into her life. And I was forever impacted by Dr. Sunshine’s ability to listen and to listen well. This was the most valuable lesson of all. I witnessed this every day. Whatever the complaint, problem, or issue, Dr. Sunshine listened actively, validated the patient and offered a positive solution. Her enthusiastic, direct conversations about the clitoris and vagina actually engaged her patients more than embarrassed them. Each patient left the office not only finally knowing what the cervix is, but also knowing she has a friendly doctor to call about her “worst ever” menstrual cramps.
That day I resolved to listen and connect like Dr. Sunshine; to hear my patients when they speak. Because, if anything, that last patient of the day left the OBGYN office heard, and sometimes being heard is the same as being healed.