How Could I Help this Patient?

Editor’s note:Was it really medical help this couple needed? Now a primary care physician at a student health center at Stanford University, in a prior practice, Diana Farid, MD, was asked by an obstetrician colleague to help with a troubling case. What she saw inspired her poem “Offline.”

Offline

by Diana Farid MD, MPH

an online meeting

an offline feeling

moved you across oceans

marriage tied your innocence

to a culture’s delusions

draped in duty’s garments

you eighteen and tangled

in your want for freedom

he is forty and some

no one ever in you

and he says he cannot

brings you to the OB

she will get you pregnant

instead she called on me

“Would you be her primary?”

I also have an eastern name

“Do you have time today?”

I met you, and him,

both in the exam room

my hand showed him out

so we could speak alone

he stood hesitant

in the hall,

like a spider guarding prey,

then on the web

began to crawl

to the waiting room,

in the hold

of his knots

sufficiently assured

you live with him

and his mother

servant

allowed outside with him,

or his brother

patriarchy

I recommended frequent visits

excuse

full physical, blood tests, vaccines

acquaintance

anticipatory guidance,

and more counseling

connection

complete review of systems:

“What is love, our purpose?”

minister

you didn’t tolerate a pelvic exam

prediction

neither did I

reluctance

no evidence of abuse

hidden

you think he loves you

innocence

believe his impotence

trust

his med list says Viagra

deception

tries to impregnate you

with a turkey baster

each barren period

amplifies his anger

rarely out of your room

cell

shouted to every chore

slave

only shame would greet you

if you returned home

outcast

answering service calls

during my vacation

emergency

told them to connect you

if you ever asked

epiphany

I spoke to the shelter

checked on your address

you will wait outside

for the car they have sent

chance

“call the human rights attorneys”

I repeatedly say

online

I haven’t heard from you though

ever since that day

offline

-----------------------------

Dr. Farid is a clinical instructor in the Department of Medicine and Staff Physician at Vaden Student Health Center at Stanford University. She has worked in Honduras, Ukraine, Malaysia, and China and cared for patients at the Los Angeles Free Clinic. Dr. Farid is an affiliated faculty member at Stanford's Medicine and the Muse program in bioethics and film, as well as a poet and children’s picture book author. She tweets @artelixer.MD Magazine asked her for background on the case that inspired “Offline.”

Dr. Farid: I had just returned to work as a family physician after a maternity leave, when I was asked by an obstetrician colleague to see a young woman in clinic. She had just left the obstetrician’s office where she and her husband had asked for help getting pregnant. My colleague said she couldn’t help. She felt something was off about the couple, triggered by a large age difference, lack of any history of sexual contact between them, and that they married at their first meeting. Perhaps as her primary care doctor I could help the patient by establishing a relationship with her, make sure her basic health care needs were addressed, and determine if there was a real need for medical assistance with fertility.

The patient was 18, had just arrived to the United States from another country and met her husband through an online dating website. She had never had intercourse and the couple had not even tried because her husband told her he couldn’t. Neither of us knew with certainty why, it may have been due to erectile dysfunction. In the course of my visits with her, it became clear that she was a captive of her husband, that her value was based on her ability to have children, and going back to her home country was not an option for her.

In contrast, I was a working mom, pumping between visits as my baby was still breastfeeding, am the daughter of a female OBGYN who had to flee her own country because of religious and gender based oppression, and majored in Peace Studies at Berkeley. Though my patient and I both had names with middle-eastern origins, our similarities ended there.

As her physician, I had to confront questions like: “What is love? What is the purpose of marriage? Is it OK that her definition is different than mine? How can I help her keep her body safe, her mind safe, her spirit safe? How do I keep her coming back for visits? How do I find social and legal help for someone like her, whose phone conversations are listened to, who is only allowed out of the house escorted, who has no money, no friends and no relatives in the same city or even country?