DRAFT: This module has unpublished changes.

Gertrude Has Polio Cancer

 

Not for nothing, but I had a certain knack for making patients feel comfortable with me. It’s part of the reason that my team at Bellevue always had something nice to say about me. It wasn’t always an easy task, and when patients didn’t want to talk to me it was pretty obvious.

 

The process of getting someone to talk with me looked like this: Anna walks down to the unit. Anna rings the bell to be let in (couldn’t you just die?) and eventually a nurse wanders over and lets Anna in. Anna explains what she’s there for – she’s there to see a patient, and that she’s from Creative Arts Therapy. Nurse sometimes welcomes Anna. Nurse sometimes surreptitiously stares at Anna. Anna smiles. Anna is always happy to be there.

 

Anna makes her way down long, long hallways similar to what a college dorm would have. Sometimes Anna interacts with other patients, especially if she has met them previously. Anna stands in front of the door to a patient’s shared room. Anna knocks on the door and opens it gently. She announces herself and her purpose.

 

Patient gives Anna a once-over. Patient agrees to go speak with Anna. Anna finds a quiet place for them to speak. Anna begins the interview.

 

So. Anna is standing in front of a patient watching television. “Gertrude?”

 

Gertrude takes a second before acknowledging me. “Yes,” she answers, taking a brief moment to scan my badge.

 

I press on. “My name is Anna. I work upstairs”—here I gesture with my pointer finger up, to indicate that I was housed on the floor above the psychiatric unit—“with the Creative Arts Therapy department. I was hoping we could sit down and talk for a bit?”

 

Gertrude pinches her face together for a moment. “All right,” she acquiesces, and I beam at her. We go to find a quiet space together, me chattering as I unlock a separate ‘visitor room” that will serve as our interviewing space.

 

Gertrude, I find, is not happy to be at Bellevue. It’s understandable; it’s not jail, but it’s not not a place of incarceration in its own way. I don’t remember what her presenting problem was, but I do remember her absolute reluctance to work with her treatment team.

 

“I’m going to court on Tuesday,” she informs me.

 

“Oh?” I’m curious – at this point in my externship, I’d only heard vague snatches of stories regarding Bellevue’s mental health court.

 

“Yes. Because they want to give me a procedure, and I don’t need it.”

 

Hmm. “What’s the procedure?” I say, thinking it’s going to be something like “please take your medication and we’ll be on our way.”

 

“They think I have cancer. I have a spot on my lung. They want to go in and poke around at it. It’s invasive, and it’s going to be painful, and it’s unnecessary. I don’t have cancer.”

 

Here’s the thing – I don’t know if she has cancer. Really, the doctors didn’t know if she had it, either. All they know is that there is something up with her lung, and they wanted to properly examine her. She’s at a hospital. It’s what a treatment team should be doing.

 

That being said, by that point I’d been working with lots of people with delusions, people in denial, and people with severe enough pathology that they would sometimes tell me something and their charts would tell me something otherwise. So it’s possible that Gertrude is misinformed, or afraid of the procedure. I would be, too. I wouldn’t want to find out I had cancer.

 

“You say you don’t have cancer,” I say—with all the compassion I can muster up without sounding condescending—“but you do have a spot on your lung. It sounds to me like you think it’s unrelated. Is that right?”

 

“Yes,” she says, pleased that I’ve caught on so quickly. Gertrude is an older woman who looks nothing like I do. Her initial wariness of me was to be expected, but I’ve voiced something that she has been wanting to hear for a long time.

 

She continues. “I had polio when I was younger. The doctor told my mother—she’s dead now—that I’d have the spot on my lung for the rest of my life. That’s what it’s left over from. But I tried to explain that to them, and these doctors – these doctors are going to go through with the procedure anyway. And I don’t want them to. So I’m going to court.”

 

Here’s another thing – I’m a child of the nineties. I’ve never given polio much thought because as far as I’m concerned it’s a disease that’s been eradicated. But Gertrude is the right age for someone who may have lived through it, and if she didn’t have health insurance or access to a doctor, who’s to say that she could have been properly vaccinated?

 

It’s a plausible story. It isn’t riddled with grandiosity or outlandishness that I’ve heard in previous patients. Gertrude may really have a scar from polio and nothing more.

It was a tricky balance to strike. I didn’t want her to feel invalidated, but I didn’t want to fuel her determination to stop doing treatment. A fair amount of my job was convincing reluctant people to take their medication. Was this really any different?

 

When in doubt, I validate, and that’s what I did with Gertrude. “I can understand why you wouldn’t want to do a procedure like that, especially if a previous doctor gave you another diagnosis,” I said—if you take nothing else away from this story, know that validating someone is not the same as agreeing with them—and watched her face for her reaction. She seemed to soften a bit. “It sounds invasive, and scary—”

 

“It is scary,” she said, her voice cracking a bit. “It’s scary. And it’s going to be painful. These young, inexperienced doctors, they just want a body to experiment on. There’s nothing wrong with me. They just want someone to practice on.”

 

God. What am I supposed to do with that? Between watching my supervisor work and seeing my own patients, this work made me quick on my feet – the best course of action is to quell some of those fears and to put treatment ideas somewhere in the back of her mind.

 

“I wonder if there’s a way you can voice any of your apprehension to your treatment team.” I’m hoping that she will pick up on the subtle suggestion.

She considers this. “They’re all young,” she says. “I don’t want to talk with them.”

“You don’t think they’ll be able to understand where you’re coming from.”

“Yes. I think they have already made up their minds.”

“Okay. Let’s say that happens – that they’ve made up their minds, and they decide to go through with checking out your lungs. What, Gertrude, can we do to make you feel a bit better afterward?”

 

Gertrude—to my luck—is game to talk about the future. We are chatting about her life when she suddenly informs me that her aunt once received treatment at Bellevue. “She got better,” she says, voice a bit more subdued.

“That’s wonderful,” I tell her, and I mean it. “See? You’ve had other people in your family receive treatment at Bellevue, and they were better for it. I wonder if that will happen for you, too.”

“That’s different,” she says, suddenly reclusive again. “She was sick. I don’t have cancer.”

 

I don’t remember how the conversation ended but I wrote everything I could remember in her medical record, feeling guilty all the while. My supervisor once told me that of the notes doctors check, Creative Arts was not one of them. It is likely that Gertrude went to court. It is even more likely that she lost. I am nearly certain that she was checked for cancer. I don’t know what they found.

 

At what point am I responsible to advocate for a patient’s comfort? Even if she’d had cancer, what are the ethical considerations of her declining treatment for it, especially if she was under Bellevue’s care? On an entirely different plane of thought, who is listening to the psych student trying to tell a doctor how to do their job?

 

I take a significant comfort in knowing that Bellevue is a public hospital, which means the way doctors make money is very restrictive. It is likely that they wouldn’t be carrying out this procedure if they weren’t genuinely worried about her health. I am positive that no one was looking for a body to experiment on.

 

In some ways, I have to be sure of those things. This work would tear me up otherwise. I need to believe in the work I am doing. I need to believe that when I am slyly convincing patients to take their medications, I am doing the right thing.

 

Some days are easier than others. No one is entirely comfortable with the thought of being prodded at by doctors. When I ask myself if I am in the right line of work, I usually answer with a resounding “yes.” People like Gertrudeand my mission of convincing them to acquiesce to our demandsmake me question that.

 

Everyone has tough days at work. This was one of mine.

DRAFT: This module has unpublished changes.