My first appointment on that rainy Monday morning was a 24 year old woman there for her annual health maintenance visit, Pap and contraceptive review. We talked about her wedding...
The name on the encounter form clipped to the door was not familiar, but when I entered the room I recognized her. I’ve been taking care of her since 3rd grade (along with a brother serving now in Afghanistan, both parents, and a surviving grandfather - and I cared for her grandmother through her failing years with emphysema). Seeing her familiar and smiling face with a new name, I recalled that when I saw her last year she had been planning a wedding.
As I sat down and logged onto the computer, I started with one of my collection of open-ended greetings...
Me: “Good morning and happy Monday. How have things been since you were last here?”
Pt: “Pretty good. I quit smoking. (Pulling a picture our of her bag and handing it to me.) Look. You saved my wedding.”
Me: (Looking longer than necessary at a picture of her in a wedding gown next to a tuxedoed young man I took to be her new husband and flanked on each side by sets of puffed up and proud parents., while I tried to figure out what she meant.) “Nice picture. What’s that about me saving your wedding?”
Pt: “You see lots of people, so you probably don’t remember. That’s ok. (This happens a lot, and I always ask myself are they really saying it is alright, or are they gently chiding me for not remembering.) When you saw me last year I was freaking. I couldn’t sleep, I got upset over little things. My supervisor wrote me up for my attitude when she told me I had made some silly mistakes on an account. (She does customer service for a local cell phone store.)”
Me: (Remembering that she had been stressed by trying to plan a perfect wedding, but still not sure where she was going with this.) “Oh, yeah. You were trying to make everything perfect and it wasn’t working. What was it, the invitations?”
Pt: “Everything. Everything cost too much. I couldn’t make decisions. Everyone wanted something different. My brother didn’t want to wear his uniform...I just couldn’t stop thinking about what was going to go wrong next.”
Me: (Silence, leaning forward slightly and tilting my head just a bit to the right. If you don’t know what to say, make eye contact, relax, and give the patient time.)
Pt: “You told me that I was worrying about the wrong thing. You said worrying is really, really important, but you have to do it right to make it work. And then you said I should worry that nothing would go wrong, that everything would go as planned, and that the wedding would be just like every other wedding, boring and ordinary, and that it is the glitches and surprises that make weddings special and memorable.”
Me: “That helped?”
Pt: “Not at first. I was pretty stressed when the printer used the wrong font on the invitations and when the table cloth was the wrong color and didn’t match the gowns. But it was the sneezing. You fixed the sneezing.”
Me: (Totally lost.) “Sneezing?”
Pt: “The ceremony was going fine, my parents got through their lines and it was time for the rings. It was quiet and everyone was watching. And then this little baby in the back of the room started sneezing. Again and again. Little baby sneezes. About 10 or 15 of them, right in a row. I started to panic, and then I remembered what you said. So then the pastor turned to the audience and looked out at the baby and he said quietly with a big smile...’Yes, you’re right. Weddings are nothing to sneeze at.’ And suddenly I stopped freaking and hoped someone got it on tape, ‘cause it was just the coolest thing.”
Me: “Well, did anyone get it on tape?”
Pt: “Oh yeah. My aunt. She was in the same row as the baby and got the baby and her sneezes and the pastor. My husband and I watch that video again and again. It was the best part of the day.”
The rest of the visit was unremarkable. She had, indeed, quit smoking, not because I had been nagging every year, but because they were planning a pregnancy in the next couple years. Other than congratulations and support, I had little to offer or add - and told her as much. After the visit, though, I went back and looked at my documentation from last year. There it was. In the social history: ‘Stressed by self imposed expectations for planning perfect wedding, moderately symptomatic with anxiety.’ And in the Assessment/Plan: ‘Situational anxiety: brief supportive counseling. RTCB. (reasons to call back)’ Not much to see in the documentation. Even reading it in the context of hearing how it had impacted her, I had little recall beyond a brief conversation about the joys of accepting the granularity and serendipity of life, that the spice and excitement comes not from what we planned, but from the things that happen in spite of our plans.
And so it was with this visit. The joy (which lasted well into my busy Monday) came from the social ripples generated by an unscripted remark, life’s adventures, and my willingness to let patients tell me about their lives.