Seeing Faces
© Lauren Dennis, MSI
It was neurology clinic where I was confronted with a patient who had a face which didn’t match what I had imagined for her to have. The blueprint for the face I expected evolved from the pages of electronic records which revealed actions that suggested narcotic addiction. “Left AMA when refused opioid treatment.” “Pain level reported 10/10 while patient was eating lunch.” “Third ER visit this month.” Having never encountered a patient with their face set on a specific medication, I was afraid. Afraid to be swirled into pity for what I anticipated to be an exaggerated history. Afraid to be confronted with hostility or demands to which I had no acceptable response. Afraid to waste my compassion on lies.
I walked into the room with determination to not get played. I had the memory of her records ingrained in my mind and my eyes fixed on finding an inaccuracy in her story. After a series of questions, I stepped out to present to my preceptor to which he responded, “Did you ask her to describe her pain?”
No. No, I hadn’t. It was a question so simple and so common that its absence demonstrated more than its presence would have. It disclosed that the trajectory of my questioning was towards proof of fault rather than understanding. When we went back to conduct a physical exam together my preceptor pointed out her asymmetrical facial droop. She still had bilateral motor function, so this observation confused me. “Bell’s palsy?” I questioned. He responded, “No, sometimes when someone has severe trigeminal neuralgia, they can have a facial droop purely out of painful exhaustion within the nerves.” In a moment my vision cleared, and I saw the objective proof of pain in the face that only moments ago had sat before me. In my effort to not be blind to her schemes, I became blind to her. Yes, she may have real drug-seeking behavior, but she also had real pain.
I know my inexperience. It stands high in my view, overshadowing my daily steps. When I faced this patient, I ran from compassion in the fear of exposing my naiveté. Yet, isn’t that so often the crack our frustrations find space from which to grow? We, as medical professionals, are afraid our ability, expertise, or plan will be usurped by the familiar foe of insufficiency. Insufficient evidence. Insufficient understanding. Insufficient narratives of the variables at play.
I will always have blind spots and weakness. Omniscience is not a prize that is on the table to be won. Compassion requires love and love requires trust. Fundamentally, to trust means you must accept some level of vulnerability. C.S. Lewis wrote that if we reject vulnerability in our efforts to keep our love safe, “It will not be broken; it will become unbreakable …” Some people believe that to trust you must keep your eyes half shut. I am beginning to believe the opposite. Maybe trust is most fully experienced when moving forward with eyes fully open, acknowledging the broken as well as the believing for the beauty. I missed seeing the whole view of my patient because I had constructed a narrative that I would not allow her to break. It was pride and fear that blinded me, but it was vulnerability and compassion that helped me see.
“Perfect love casts out fear.” (1 John 4:18, Holy Bible)