Silence

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Laura Morgan, MD

Spring 2006 - Volume 10 Number 1

https://doi.org/10.7812/TPP/05-051

Maggie taught me about silence. Three years ago, with a nasty case of laryngitis, I went to clinic as usual and let patients know that I would be essentially silent during their visit. Most appointments went smoothly, in fact, more smoothly and quickly than usual, which should have been a hint. But Maggie’s visit, to this day, stands out in my memory most powerfully.

I knew her as a type 1 diabetic, accident-prone, morbidly obese, self-deprecating woman who lived in a trailer with her chronically ill, demented mother and her troubled sister and niece. Every previous visit with her had brought reports of conflict, injury, frustration, poverty, and sometimes theft. On the day of laryngitis, I resigned myself to listen passively instead of actively trying to make a difference for the better in this unfortunate woman’s life.

I indicated to her that I wouldn’t be able to speak during our visit and, with that, she was off and running. For the first time since our first visit, ten years ago, Maggie told me the story of her abusive father, her “silent” mother, her deliberate decision to gain weight in order to repulse her father’s advances after she heard him express an aversion toward fat women. She told me about protecting her younger sister, with whom she was now living, by offering herself as bait to her father until her sister was old enough to defend herself. She imitated the words and voice he used to initiate physical contact and how, to this day, despite his death, she can still hear his voice.

I think it took her all of ten minutes to explain her life to me. She expected nothing in return but my attention. She left the office in what seemed a remarkably lightened mood and told me it was the best visit she had ever had with me.

Since that day, Maggie is still my patient, now taking two hours to travel by bus one way to my new office. She never complains about the distance and she’s never late.
Since that day, Maggie exercises and diets on her own and has lost over 100 pounds. She is highly compliant with her medication regimen and her chronic disease is in optimal control. She has not fallen down or injured herself accidentally again. Maggie placed her mother into skilled nursing care, helped her sister raise her daughter, set and enforced behavioral guidelines in their home, and became a fine seamstress. I treasure the pillow she made for me; I try to imagine placing it firmly over my mouth whenever I feel the urge to tell someone how to live without first understanding something of his or her life.