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A Place To Start
J Gen Intern Med
Emily Josephine Alfano 0
FNP-C 0
0 46 Warren Street, Apt 3, New Haven, CT , USA
-
B me. So, where do we start?
ehind a closed clinic door, two feet between us. You and
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. (...truncated)