Sunday, August 15, 2010

Reflection from the Grady Wards: You are Beautiful, No Matter What You Say

*details, etc. changed to protect anonymity. . .

"You are beautiful no matter what they say

Words can't bring you down

You are beautiful in every single way

Yes, words can't bring you down

So don't you bring me down today. . . ."

From Christina Aguilera's "Beautiful"


"Those sores on your face. Is it from. . .picking?"

"Yeah, when I'm high I pick."

I studied her young face. With the exception of the handful of gouges on her cheeks and chin, it was a beautiful face. Pore-less skin like porcelain with striking blue eyes framed with the kind of eyelashes celebrities pay big money for.

"How long have you been using?"

"Uuuhh. . .what?"

"Using. How long have you been using the meth and the heroin?"

"Ummm. . .high school? Middle school? Man, I don't know."

She kept wringing her hands in her lap. A star was tattooed on three of her knuckles and her fingernails had been gnawed down to nubs. Both of her inner arm creases and forearms were covered with more intricate ink; perhaps to camouflage needle tracks from the average onlooker. But to a doctor working in a public hospital, the shiny scars that distorted each tattooed image were exactly like seeing a hand caught inside of a cookie jar full of intravenous drugs.

"My resident mentioned that he'd spoken to you at length about getting some help. I know this is a lot, but we really want to offer you some help. A new life. When you came in, you could have died. You aren't even 25." I paused and tried to get her to make eye contact with me. "I'm so happy that you are doing better. This could be a second chance, you know? What do you think?"

:: shrug ::

She brought her filthy nails up to her teeth and began nervously chewing at the little piece remaining. Perfect teeth, like dentures. Unusual for someone who used methamphetamine, but reason for me to find her that much more striking than I already had. She was beautiful.

She gave up the nail-biting and moved to scratching her arm. She let out an exaggerated yawn. I was boring her, I could tell. I felt like I needed to at least ask.

"Have you ever been in a treatment center?"

:: yawn ::

She craned her neck from side to side as if removing a "crick." That's when I noticed the sprinkles of needle marks dotting her jugular vein like purple confetti. The drugs had destroyed all of the vessels in her arms and legs. Or maybe not. Maybe the neck was just faster. Closer to the brain.

I stared incredulously at this beautiful stranger. How did this happen? How? I imagined her sitting cross-legged on the floor of her pre-school during "circle time." Raising her hand high for the teacher to pick her. I saw her turning cartwheels on a bright green lawn in front of someone's house and laughing at a kitchen table until milk squirted from her nose. I could see her as somebody's baby, peering up at someone with those same haunting blue eyes, and them whispering a lullaby to her in a rocking chair. I felt a pang of grief for the loss that that same someone is probably feeling at this moment. . . .

"Can I go?"

I stared at my billing card and registered her current clinical state: respiratory status, kidney function, and hydration all back to normal. Evaluated by Psychiatry, but declined treatment. Not suicidal. Decision-making capacity intact. Still precontemplative about rehabilitation. Clinically, appropriate for discharge.

I startled myself when I uttered aloud, "You are so much more than this. . .and you're so beautiful." I am still surprised that I spoke that part, but I went on. "You are so much more than--"

"What time can I go?"

Save the sermon, her expression told me. The only two words she had for me and my soliloquy were "over" and "it."

That's when I had to accept that she wasn't ready, and that I wouldn't get the satisfaction of seeing her leap from the bed and hug me in gratitude for guiding her to a new life. I had to accept that most times it isn't that way, but you still have to try. What if this was the day for her? What if God was counting on me to encourage her and I didn't try? Sometimes I wonder if I'm just being Pollyanna or high-on-my-horse to think that, in a person this far from ready, any thing I'd say would make any kind of difference whatsoever.

I circled "discharge" on her card.

"Right after lunch," I answered her flatly. Suddenly I felt very sad.

"That's okay, I'm not hungry. . . .can I go before that?"

"Okay, then as soon as we complete the discharge paperwork--maybe a half hour?"

Then she smiled wide and beautiful and genuine; the first smile I'd seen since we met that morning on rounds. She didn't even try to hide her happiness with that verdict as she fished around in the bed sheets for her cell phone. She poked the phone keys with her stubby thumbs, entering a feverish text to whomever would clearly be her savior from all these folks caring and preaching and asking her all these questions.

"Thirty minutes, right?"

"Yeah," I replied, "or less."


For some reason this song kept playing in my head after I saw this patient . . . . and for the rest of the day. . . . . praying she is okay and that she eventually sees what I saw.


  1. so sad. there are few things as heartbreaking as watching someone who is lost to addiction. at least you tried and i'll bet you that some day she will remember that one doctor who told her she was so beautiful. maybe no one ever has... you never know, right?

  2. Really, really sad.

    My mother-in-law was addicted to meth for a long time (before I knew her) and, while she was functional, it was clearly destroying her. It took losing custody of her kids (my J, when he was 14) to make the choice to try to break the cycle of addiction. And she quit cold turkey, and hasn't used once in the 11 years since, and has a great relationship w/ J now. I think about her a lot when I hear such sad stories like this one about addiction--I'm sure having her children taken away from her seemed like the end, and to anyone on the outside looking in I'm sure that might have looked like the straw that broke the camel's back, but instead it was a huge turning point. I definitely hope your patient is able to gain clarity and seek help, and you never know--even if she acted like she blew you off, maybe your words went a lot deeper than she let on.

    I hope so.


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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