About a Girl

girlProfileAs a nurse practitioner, I often encounter patients and situations that seem, for one reason or another, overwhelming. Sometimes there is too much happiness – the good outcome of a test, the birth of a healthy child. Other times, there is too much sorrow. Some days, I doubt my own skills; often, I’m exhausted by listening all day to stories of pain, illness, lost hopes.

As a writer, I’ve learned that revisiting those overwhelming emotions and turning them into poems, essays or narratives can help. Looking again through a creative lens lets go of those moments and, at the same time, holds on to what is most important about them: the way patients’ lives intertwine with ours; how we move together through happiness and crisis, step by step.

I also know that it’s not necessary (or ethical) to retell any patient’s story exactly: we are, after all, their protectors. What we’re after is not the facts but the emotional truth of any encounter. It doesn’t matter that this patient’s name wasn’t Alicia or that I’ve made up her appearance and altered the timing of our interaction. What matters is capturing the lightning flash, the thud in the gut, the essence of a patient’s gestures. Such images then become the metaphors that reveal what’s universal and human about a personal experience.

When we share what we write with other caregivers, we reveal the doubts, frustrations and joys of our professions and strengthen our bonds with one another. When we write creatively about our work, we also say thank you to our patients. This is for all Alicias.

Alicia sits on the exam table before me, freckles scattered here and there across her nose. Her mouth is bowed. She is 12, with dark brown hair, pale brown eyes, and a resigned, hollow stare.

I sit at her feet on my round rolling stool. I feel as if I am both her nurse and her confessor. Alicia’s mother is here, too, a small, sad woman who sits in the corner in a straight-back chair. Alicia shivers. She fixes her gaze not on me but on the beige clinic wall.

She tells me that the man came into her apartment when her mother was at work; her sister was shopping. I don’t ask, and Alicia doesn’t say. Did he speak or cajole? Did he cover her mouth?

When her sister returned, she found Alicia huddled in bed, the sheets rosy with blood.

In the Emergency Room, the doctors opened the rape kit, and Alicia clutched her ears to keep from hearing and covered her mouth to keep from screaming. Under the glare of the overhead light, the physicians inspected her clothes, scraped under her nails, swabbed her throat, her vagina, her rectum, pulled a tiny-toothed comb through her pubic hair. The light revealed a laceration deep in her vagina, so the doctors sutured it – three stitches to join the crimson walls, to hold Alicia together. They drew her blood to test for pregnancy, syphilis, hepatitis, HIV. When the doctors and nurses were finished, Alicia went home, a hollowed-out girl.

Now, two days later, I’m the stranger examining Alicia’s healing vagina, her innocent labia. I’m the nurse practitioner ticking off the results: negative pregnancy, negative syphilis, negative hepatitis, negative HIV. I’m the woman who has never been raped, telling Alicia that the still-sharp sutures will dissolve on their own. When, because I don’t know what to say, I take hold of her hand, she tells me that the man was a friend of a friend. I’d met him once before, she says. I smiled at him when he walked in.

Because I’m unable to help Alicia shoulder her grief, resolve her guilt, I call the women’s center to make sure the special counselor is on her way. Perhaps she will help Alicia carry the burden of nightmares, the way her thoughts and dreams punish her now, tossing her to and fro.

“I would rather he killed me than raped me,” is what Alicia says.

I’ve lost my words, lost my thoughts – lost everything but touch. I move closer, still holding Alicia’s hands in mine, enfolding and warming them.

“Am I still a virgin?” she asks me.

I struggle not to look away. Like Lady Justice, I weigh Alicia’s words, trying to balance the question and the words behind the question. In one hand, a pound of flesh. In the other, the shimmering spirit.

Alicia’s mother leans forward. She wears cloth shoes with worn-down heels. She clutches a pocket book in her lap, and under the lackluster clinic lights the patent leather shines like the sun.

“You choose to give your virginity, when you want to,” I tell her. “Of course! You are still a virgin.” Gracias a Dios, Alicia sighs.

Her mother, nodding, understands the lie.

Alicia tightens her hands in mine. Maybe she believes she will never fall in love. Maybe she fears ever having sex again.

I help her down from the exam table. I give back her polyester skirt; hand over her white cotton camisa; hug her; smooth back her hair.

Alicia’s mother and I step out into the hall and wait together beside the closed exam room door. All the noises of the clinic assault us. Babies cry; phones ring; beepers squawk; nurses rush by.

Not speaking, just holding each other with our eyes, Alicia’s mother and I stand guard, fierce and protective, while Alicia dresses.

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