I felt a bit tainted as I headed out to my first memorial service for one of my patient’s since starting my job as a college health physician. I had seen many people pass away over my training years -- some old, some young, but this felt different, somehow. Because she was the saddest girl I had seen in a while.
As I entered the relatively large room filled with many young faces from our student body, I was pleasantly surprised. Because she was the saddest girl I had seen in a while, she had always seemed all alone. But apparently, she did have friends after all, whether she had realized that or not.
None of her family was present as I scanned about the room. More peers than I had expected. A few professors. Her college house dean. From the college house where her lifeless body was found, hanging in her dorm room.
I was originally asked to see her at the health center by my colleagues at the counseling center as there were “weight concerns”. And while she was definitely tall and lanky in appearance, the cut marks on her forearm that she hid from me, the perpetual pout, and the poor eye contact seemed far more pronounced than her slenderness. I was later to learn that my colleagues at the counseling center had known about her rope. They had surely heard all of the “suicidal ideations” she spoke of. I had too. While I saw her for her “medical” needs, once even throwing sutures into her frayed arms, I had heard of how she would be “better off dead”. I had seen the disturbing pictures she drew for me. I heard about the threats (and yes, even thwarted one of her attempts by staging an intervention). I reached out to my colleagues. They seemed confident that she was getting enough care. I was to keep to the medical aspect and leave the mental health aspects to them. She remained the saddest girl I had seen in a while.
The day she asked for a hug, it seemed a no-brainer. She was in my office – unhappy -- the saddest girl I had seen in a while. She clearly hadn’t had an upbringing with a lot of affection.
And I like to think of myself as part-doctor, part-mother in my role as a primary caregiver to the students at my university, and our health center a kind of “home-away-from-home”.
That was the first and last hug I gave her.
Regrettably, there was not a lot of collaboration in her care, despite many attempts. I was reminded that, as her physician, I was to tend to her medical needs. And worse yet, I was “scolded” for having given her a hug… having crossed that line…per my mental health associates.
Why I felt shamed into refraining from providing a therapeutic touch to her again by my colleagues, in spite of her asking me for hugs on subsequent visits, I will never know. But the morning I was paged by the Emergency Department… and my half-asleep ears heard the resident inform me that there was a patient in critical condition who attempted suicide…and her name matched that of the saddest girl I had seen in a while…I felt the regret the strongest.
Would my hug have prevented the saddest girl in the world from making such a bad decision? Unlikely. But I might have slept better knowing that I had given her that hug. I believe the biggest privilege one earns in medical school is to learn how to touch a patient. Besides the thorough hands-on physical exam, there is something to be said for a touch on an arm, a hand on the shoulder, and yes, even a hug. Maybe we should all learn to recognize the therapeutic value of touch?
At least I was able to touch her shoulder as she lay in her ICU bed, attached to too many tubes to count, with purple marks across neck. Her asphyxiation kept her in a deep slumber that she would never awake from. She may have even had a wry smile on her face as she lay there. Maybe she wasn’t so sad anymore. That, too, I will never know.
Back in the memorial service filled with her mysterious friends, my legs unexpectedly took me to the podium where I was able to tell her… and her peers… and the college deans… and my mental health counter parts to go ahead and give hugs… as sometimes a hug is all you need to feel better.
Vanessa Stoloff, MD is a physician at University of Pennsylvania Student Health Service since 2003. She “specializes” in all primary care concerns, but has extra interests in travel health, eating concerns, and dermatology.