A Place To Start

Behind a closed clinic door, two feet between us. You and me. So, where do we start?

You are a Naval Officer. Thank you for your service. Did you see combat? Yes. The tears in your faded blue eyes surprise us both. I’m apologetic and so are you. You flash a broad smile and deep lines draw a map across your face, hinting at places you’ve been. You tell me you find yourself thinking about the War more these days. You tell me about the bullet that shattered your tibia, about thinking you had died and gone to heaven when you woke up on the ship, surrounded by nurses: Beautiful! All of them! Your worn, thin body counters the pressure of my stethoscope on your chest. You breathe deeply through fibrotic lungs. Ninety-two years of life are written across every inch of you but your power is present still.

You are an Army Ranger. Your dark brown eyes dance around the room, seeing everything but my gaze. Your fingers, swollen with arthritis, grip the sides of your chair. Six-foot two has never looked so small. Your voice, booming in 1969 when you went to war, is barely audible today. You fumble when I ask you to remove your shirt and your stomach muscles tighten as I palpate your abdomen. You flinch when my fingers press into your wrist, feeling for your racing pulse. My exam is syncopated by your scuffed boots, tapping the floor, waiting for permission to march out the door.

You are a Marine. My brother’s age. You walked into my office with purpose. You are kind, polite, and respectful. And then. And then you look at me and your green eyes invite me in. I know it’s fucked up; but, sometimes I just wish I was back in Iraq. I am startled by the matter-of-fact way you say it. By the relief you so obviously feel when you talk about being back in a war zone. Your voice is steady. My mouth is dry. I watch your shoulders relax. You see my hands shaking. Your eye contact is unwavering: I hide mine in the pages of your medical record, wondering if you see my tears. You invited me into your world and it is the scariest place I have ever been. You want to believe me when I tell you it takes courage to ask for help. We both need to believe I can help.

The door is closed. It’s you and me. Let’s start there.

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Correspondence to Emily Josephine Alfano MSN, FNP-C.

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Alfano, E.J. A Place To Start. J GEN INTERN MED 32, 365 (2017). https://doi.org/10.1007/s11606-016-3762-7

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  • Arthritis
  • Medical Record
  • Iraq
  • Stomach Muscle
  • Thin Body