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Our daughters, ourselves

Maurer, Brian T. PA-C

Journal of the American Academy of PAs: March 2017 - Volume 30 - Issue 3 - p 58
doi: 10.1097/01.JAA.0000512248.81742.86
The Art of Medicine

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com. The author has disclosed no potential conflicts of interest, financial or otherwise.

Tanya Gregory, PhD, department editor

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She's the first patient on my morning schedule: 19 years old, here for a physical examination required by her day-care employer. I've never laid eyes on her before; don't know her from Eve; don't know her name. Hurriedly, I scan through the pages of her chart, hoping to glean any salient points of historical data; but it's hopeless. I can scarcely decipher the chicken scratches on the paper pages. In the end I resign myself to my fate, knock on the door, and enter the examination room.

There she sits, fully clothed, on the examination table. She's tall and lithe with long straight hair, high cheekbones, and slender fingers. I introduce myself, smile, and offer her my hand. It's all she can do to flash a fleeting smile back.

“You need a physical exam for work?” I ask, opening the chart on the countertop. Silently, she nods her head.

“How have you been since we saw you for your physical last year?”

“Good,” she says, flatly.

“Any interim illnesses, trips to the emergency room after hours, surgeries, broken bones, allergic reactions to medications?” She shakes her head no.

“Have you completed the questionnaires the nurse gave you?”

Without a word, she hands me the clipboard. I look the forms over. “I see that you do drink occasionally, but you have ridden in a car with someone at the wheel who's been drinking? I guess the take home message is that you should always plan for a designated driver.”

“That's hard to do when the driver happens to be your parent,” she intones.

I look up from the form. “Yes, that's very true. Has that happened to you on more than one occasion?”

She shrugs her shoulders. “Sometimes,” she says.

I let my eyes drift down the template in the chart. “Are you in an intimate relationship with another person?” I ask. “Having sex?”

She nods her head.

“Using any form of contraception?”

“Condoms,” she says.

“Every time?”

“Mostly.”

“Last period?”

“Maybe 3 weeks ago.”

I finish up with my questions and start in with the physical examination. I push her hair back to examine her ear and notice that the pinna is nearly covered with a melanocytic nevus. “Does this bother you?” I ask her.

“No. I see my dermatologist every year.”

Methodically, I work my way down her body, looking in her throat, feeling her neck, listening to her heart and lungs, feeling her abdomen. I ask her to unbutton her jeans so I can palpate her femoral arteries. Reluctantly, she complies. Finally, I ask her to stand up and bend forward. Her spine is straight.

“You look to be nice and healthy,” I say.

“I need a TB test for work,” she says, handing me another form.

“You certainly do. The nurses will be in in just a minute,” I say in my most reassuring voice. “Meantime, I'll finish up your forms.”

Suddenly, without warning, my eyes fall on the immunization record in the front of the chart. I glimpse the words: Father deceased—AAA.

“My goodness!” I say. “Your father passed away?”

She slowly nods her head.

“How old were you at the time?”

“Three.”

“Do you remember him?”

“Oh, yes,” she says. Momentarily, the smile fades from her mouth.

“Who's at home now?”

“Just my mom, my brother, and me.”

“Your mother never remarried?”

“She had a steady boyfriend for a while; but eventually, he moved out.”

She cannot hide the sadness behind her eyes. Her father died from an acutely ruptured aortic aneurysm when she was just 3. Suddenly, it occurs to me that I, for the first time, am seeing someone he never saw: his little girl, now all grown up into a lovely young woman.

My two grown daughters still have their father. This daughter still grieves for the father she lost 16 years ago.

I've heard it said that you never get over the loss of a child.

I wonder if the same applies to the loss of a parent, even one who died when you were 3.

Copyright © 2017 American Academy of Physician Assistants