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Neal, Matt MD

doi: 10.1097/ACM.0000000000000168
Teaching and Learning Moments

Dr. Neal is a first-year resident in internal medicine, University of Tennessee, Saint Thomas Midtown Hospital, Nashville, Tennessee; e-mail:

For some reason, it’s always the bruises I remember first. The colors and shapes are quite well known—the stigmata of the dysfunctional relationship. What twists the knife just a little is the realization that it was me, not some moral degenerate, who inflicted those wounds on my own mother. What’s more, I wouldn’t hesitate to do the same all over again.

It was the afternoon before Thanksgiving. Mom was returning home from work to drive my little brother and me to her parents’ house for our annual family reunion. Her entrance, as she staggered into the foyer, was unmistakable, and my blood boiled as she slurred her awkward greeting.

“How much have you had, Mom?”

She offered nothing but strenuous denials, though the façade seemed to crack slightly when she had to place her hand against the wall to maintain her balance. My voice rose as hers softened, thus was our parent/child relationship completely reversed, with my little brother and me left to tidy up her mess.

After furious protestations and tearful acceptance, it was decided that I would drive the two hours to grandma’s and that my mother would indeed come with us, despite her begging to be left behind so as to postpone the inevitable reckoning. Her parents knew nothing of her secret weakness, having been kept in the dark by our years of obfuscations and evasions. The thought of them finally knowing the truth was utterly horrifying to her. The golden child’s imperfection would be unmasked in front of those whose approval she coveted most of all. In hindsight, it’s heartbreakingly obvious that the day would come sooner or later. Don’t, though, underestimate the power of rationalization, both hers and ours.

Once we finally made it to the interstate, and the reality of what was coming penetrated her very addled psyche, she began to think out loud in increasingly ominous tones: “I should never have come. This was a mistake. I don’t think I can do this anymore.” She began sobbing in the backseat; my little brother began crying as well. I faked a stiff upper lip and drove as fast as her Audi would take us. She became increasingly irate, eventually screaming at me to let her out, this instant, on the side of the highway. She would walk home, she said, and we could go on to grandma’s without her. To my shock and horror, when I refused her ludicrous request, she proceeded to open the door of the car and lean out, at which point my instinct took over. After all, who wants to call the bluff of someone who believes they have nothing left to lose? I dove for her wrist, clamping down with all the force I could muster, violently dragging her back to the middle of the car. My little brother reached behind his seat and closed her door, and we each took turns holding her arm, feigning composure, as we made our way through the mountains to the day’s inevitable denouement.

An old critical care hand turned palliative care specialist once advised me: “Palliative care is not for newbies. You need to have gone through a lot before people can take you seriously in this job. They will smell a fake a mile off.” This knowledge is no doubt very dearly bought, and it is a testament to the value, indeed the necessity, of shared experience between physicians and their patients. When my patients and their families open up to me about their fears and their foibles, my empathy for them is visceral, the fruit of many sleepless nights. I have intimate knowledge of what it’s like to be incapacitated by the fear that your loved one won’t survive the day, always secretly aware that the inevitable midnight phone call will eventually come, as it sadly did for me a few years later. I left bruises on my mother’s wrist that Thanksgiving that lasted days, but some wounds don’t heal that quickly, if at all. George Bernard Shaw so memorably explained it: “You have learnt something. That always feels at first as if you had lost something.” It is my mother’s memory that sustains my patience as those under my care come to learn this lesson as well. If only the price were not so high.

Matt Neal, MD

Dr. Neal is a first-year resident in internal medicine, University of Tennessee, Saint Thomas Midtown Hospital, Nashville, Tennessee; e-mail:

© 2014 by the Association of American Medical Colleges