The Incisive Edge of Vulnerability

I can’t forget the feeling of my chest tightening like a levy against a sea of tears. And I will never forget Mary’s eyes welling up, staring into mine, and inviting me to join her. But, I pulled the white coat between us, and while standing on the secure bank of title and authority watched as Mary drifted in a river all her own.

Mary had been in the ER enough that I was no longer surprised when her name popped onto the board. We had developed a real bond, forged as all true relationships are, through adversity. Mary had advanced breast cancer. And over the course of two years she and I passed through the chaos of the ER twenty times or more. Usually, her ticket was for a short admission to treat an infection.

This time was different. Mary’s hair was gone. Her eyes were sunken into hollowed sockets. The youthful fat that makes the contours of a woman’s cheeks so captivating was gone. She was almost gone.

We both knew it. Her eyes advertised a new peace. She was leaving the fight, and was okay with her decision. I wanted to collapse into her arms, and share in her contentment. But, I was young.

Mary had found peace with something that I was still wrestling with. She was stepping into the river to eternity and not coming out. The only thing that scared me more than death was sharing how I really felt at that moment.

Mary asked me, “how is your day going” in a way that few people have ever asked. The letting go process allowed her to be present, completely, for whomever was going to be there to share in her good-bye. She was vulnerable, yet selfless. I...was afraid.

I told my colleagues in the Operating Room an hour later that I had reassured Mary - "there, there, don’t you worry about a thing. The guy in the white coat his going to make sure everything will be just fine."

When I finished the trauma surgery I went directly to Mary’s room to give her more reassurance. But, the woman who wanted me to share a tear with her and hold her hand was gone.

I had been in the OR thirteen hours. Mary didn’t have thirteen hours to wait. And she knew it.

I thought about Mary’s tears and my fear of being vulnerable with her. It hurt deeply - enough to change something in me.

Years came and went before I realized the gift Mary had given me on the day of her passing. I think she knew that my last - unfinished - encounter with her would serve me well as a doctor.

Patients at the end of life report a clarity about matters of the heart, and often offer profound parting words to loved ones. I remember a friend’s mother telling me at the end to “find a strong woman and marry her” - a topic for future vulnerability articles.

Mary knew I was hiding behind my white coat. And, she knew that I would need the incisive edge of vulnerability to be a better doctor.

Since Mary’s passing I have had countless opportunities to turn away from vulnerable moments with patients. In each instance I think about Mary’s eyes and my fear about being human with a patient. That memory is the gift that thrusts me into doing just the opposite now. I am human with my patients.

I pick up the incisive edge of vulnerability on a weekly basis in my practice now. At times that means sharing Mary’s story or examples of my own failures. At other times that means I hold a hand and cry with him or her. And sometimes I just admit the shared lack and pray aloud.

The first rule of surgery is access. My vulnerability with patients has again and again created access to the source of much disease - the mind and the heart. Thank you Mary. I miss you.