Wednesday, January 18, 2006

The apple doesn't fall....

When newFNP was a student, she wrote a (fascinating and insightful) paper about parental loss in childhood, but specifically adolescence. It doesn't take a frigging genius to know that this is one of the most painful losses a child faces, that its consequences are potentially devastating and can be life-long. The legacy of that loss can profoundly shape the child.

Given that newFNP has such keen acumen, she should be incredibly prepared with all of the right words when a patient tells her that he or she has, in fact, experienced parental loss.

My 11-year old patient's mom died when she was 8 - complication of diabetes. My 11-year old patient is 243 pounds. Her acanthosis is pronounced. Can you see the trajectory?

She knows. I know.

She is scared. She is terrified to have her sugar checked because what will happen to her if she has diabetes? Will the same end meet her as met her mother? And she is only 11.

It is so complex. Her dad tends to give her whatever she wants because he cannot give her what she has lost. So she gets honey buns and Hot Cheetos. She is too young to know how to really do anything different. She is too scared to honestly talk to me (in 15 minutes) about her weight because of what it signifies.

This is the poignancy of family practice. This family is in crisis. They both need to make changes and they both need support following their loss. I want to give them the tools to mend their family as best they can. But 15 minute appointments. Damn.

I don't know if what I did was right, but I told her that I was there to help her and that I wanted her to know that there are people in this world who care for her, who love her. I told her that I would be there for her even when she wasn't sick, that she could come in just to talk if she needed to. I told her that my mom died when I was young because I remember thinking that I was the only person in the world who could ever experience such heart-wrenching loneliness. Shit, I hope that still falls within the confines of holistic care. Patients feel free to ask me about my marital status and parity, so I can tell other patients personal stories if they are relevant, right? I just wanted her to know that she had somewhere to turn and I didn't know how else to make her see that.

And now I need to find a childhood grief specialist. Who takes public insurance. Motherfuck.


Anonymous said...


your response is so thoughtful and so appropriate and so important to that girl. she is lucky to have you.

Anonymous said...

It's hard to deal with patients who are dealing with things that we've experienced (and, of course, are still dealing with in one way or another). Being human cuts across those roles sometimes. Good for both of you. I feel for her. All 243 pounds of her. Keep up the good work you fabulous, new, educated, tired, public health-y FNP.

Anonymous said...

Decided to read your blog before going to clinic this AM and am crying in my kitchen. Your patients are so lucky.
Let's talk soon.