Those Eyes

Buchan, Susan

Those eyes. That’s all I recognized at first. Those muddy brown eyes carefully following me into the examining room. I slowly begin to remember the rest of Mark, another long lost patient of no fixed address who had simply dropped off the radar many years ago. He didn’t say a word, he just handed me a hospital discharge report to speak for him, a long list of acute and chronic conditions and hints of dubious circumstance; “found  unconscious”, “subdural hematoma”, “right lower lobe consolidation”, “Hepatitis C”, “address unknown”, “next of kin unknown”. All of this lept off the page, a sinister collage of an uncertain broken past and renewed trauma.

Mark had first come to see me approximately ten years ago accompanied by a social worker looking to change his life starting with a move indoors. Mark had inhabited the Downtown Eastside for years, living dangerously amongst fellow drug users, the homeless, the disenfranchised. “At war with the world” he used to say. I never saw Mark long enough to sleuth out his complete story, his past, his explanation.  After my last encounter with Mark, he had slipped through yet another crack and was living outside again but this time in the suburbs with a group of other people who had set up camp by the river. “This time I have a roof “ he chuckles with a bit of a mischievous grin. The so called roof afforded by living under one of the bridges spanning the river.

Mark began to tell me about his admission to the hospital a couple of months ago. A fall off a cliff precipitated by his intoxicated state.  He was found unresponsive by some of his fellow bridge dwellers who called 911, using the cell phone of a passing by hiker. Mark stayed in the hospital just long enough for his acute injuries to stabilize, pneumonia to be treated and a for a few precious nights in an actual bed eating real food but not long enough to really address the chronic medical problems or the dire socioeconomic reality. He left the hospital against medical advice and returned to the nest he and his fellow ‘warriers against the world’ had created for themselves.

So here he was in front of me. But why now? The answer came with a quiet knock on the door. A seemingly young woman cautiously entered the room and took a seat by Mark, placing her hand gently on his shoulder. She appeared very fit, tanned and ostensibly affluent.  Well dressed, expensive accessories, exuding the impression of someone who took great care of herself and of others.  I had to pause in my line of questioning of and listening to Mark to find out who this unlikely companion was.  At first I thought that she was a social worker but there seemed to be a more intimate and familiar engagement. She introduced herself as Pam, Mark’s ex-wife with whom she had had two children who were now young adults. Trying to veil my surprise I encouraged Pam to press on with her story, for I knew there must be quite a story to tell. She explained that she had very recently re-connected with Mark as a result of an unlikely encounter.

Pam told me that she was a competitive marathon runner and that she had been training for an ultra marathon by running longer miles, which meant she was venturing greater distances from home. Recently she had started to routinely run a route that took her on a trail carved along the river bank. A couple of weeks ago she was out for a run by the river and she passed under one of the many bridges along the way. Again, she noticed a group of homeless people huddled together, ensconced in blankets, sleeping bags and meager fragments of comfort. This time, for some reason, she ran a little slower and looked a little closer at the group. She was struck by something recognizable, something surprisingly familiar. Those eyes, those unmistakable brown eyes peering out from the layers of camouflage.  She ran a little further down the trail, confused, not knowing what to do. She stopped abruptly and then slowly returned for a closer inspection. Again those familiar eyes were set upon her. The very eyes she first knew at a tender young age, the eyes she nurtured, comforted, pleaded with and then endured. The eyes of both of her children she continued to be guided by. Tiny beacons of light transcending souls.  As her shock eased off practical measures took over and Pam made her unthinkable awkward re-introduction to Mark. A longer conversation ensued and she was somehow able to coax Mark to seek meaningful help. Part of the thorny journey included another trip to the hospital followed by a visit to my office to establish regular medical care, to set up referrals and to initiate the necessary paper work to access social services and housing. 

Her story abruptly ended with a renewed focus on Mark’s pressing medical issues and the elusive care plan that had yet to be conceived.

I shifted my attention to Mark and I began to notice that there was something missing from those eyes.  A lack of recognition with a kind of dullness that had set in, matching the blunted expression he conveyed. The look of benign neglect that I had seen before in the eyes of those folks who had endured long standing suffering, those who had never found their place in this world and those who had never felt acceptance. A profound detachment that moves in following the divorce from hope. I was transiently consumed by that deep seed of hopelessness that had arrived with Mark and filled my examining room.

As I reviewed the investigations and referrals that we needed to arrange with Mark, Pam became the active listener, her eyes conveying an earnest interest, her comments revealing a measured hope. Conversely, Mark sat impassively, providing me with a nod or a monosyllabic answer when necessary. My efforts to portray hope and possibility, although necessary and expected, felt simply false and disingenuous. The reluctant actor miscast for the part. And then as I looked at Mark closely I could see that he too was trying to play a part, conspiring in the role, appeasing the audience, to please someone, anyone.

I escaped to the tedious relief of completing the pile of paper work before me, distractedly filling out each of the closed ended questions. Again I looked up to Mark into those brown eyes, looking for unlikely hope, a sense of possibility. Those brown eyes stared right back at me and for just a moment I thought maybe they were looking for the same.    

Theme: Community | Communauté
Theme: Family | Famille
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Patients | Patients
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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