The Heart's Truth: Essays on the Art of Nursing

When Their Rhythms Become Mine

83 When Their Rhythms Become Mine Working as a nurse practitioner, serving uninsured women and teenagers, I’ve gotten really good at doing first exams. I even have something of a reputation: fifteen-year-old girls come in for an appointment and say, “You did my friend’s first exam and she said it wasn’t too awful.” Some of the nurses steer the first exams my way as well. When she hands me a chart, a nurse might say, “I’m glad it’s you. It’s the patient’s first pelvic and she looks scared to death.” When I was younger and horseback riding was my passion, I was also good at calming skittish horses. I couldn’t get the sluggish mare moving, no matter how I kicked and prodded, but when I encountered the wild-eyed ones something mysterious happened. If a frightened chestnut jigged sideways or took off running, I would let my weight sink into the saddle, settling back as if nothing could dislodge me, and the horse’s rhythm became mine. The animal’s muscular energy flowed into my body and rose up through my spine until I could feel myself softening and accepting. As I slowed my breathing and let myself linger one beat behind the horse’s movement, a peaceful calm settled over us. Little by little, my body and the horse’s body became one. The young women I see in the clinic are wild-eyed too, like foals weaned too early from their mothers. These girls prance in for their initial appointments, all nerve and pretense. Sometimes they want a Pap test. Other times they think something is wrong and want to be checked. Then, behind the closed exam room door, when they shed their clothes and pull on their johnny coats, they become frightened, unpredictable, and lonely. I’ve learned how to place my hand on a girl’s arm, just for a moment, allowing some of her fear to escape, just as that good nurse once placed her hand on my arm, saving me. I’ve learned how to drape a young woman’s body so that she isn’t exposed, and I know how to do an exam in a controlled, calm manner, letting the patient’s rhythm become, for that brief span of time, my rhythm too. Because my body is like my patients’ bodies, we can chance the mysteries of this exam. 84 the heart’s truth At the end of my riding lessons, I’d return to my suburban home where I’d have a good lunch of hot soup and sandwiches. My parents loved me. But many of my patients, abandoned by their mothers, come to the clinic for their first appointments alone. Some of them have been raped by their friends, brothers, or uncles. Jittering from one relationship to another, many of the girls I see have chlamydia, herpes, abnormal Pap tests, and other diseases. They smoke, sometimes they use drugs, and long before they are old enough to drive or buy cigarettes, they become sexually active and blind to the consequences: sad lives, infertility, abortion, grief, cervical cancer, fractured bodies. I was never afraid when I rode horses, not worried about falling off or breaking bones. But when I first came to work in the clinic, I was afraid of these girls, tough girls with tattoos and loud mouths who shouted at each other in the waiting room and sometimes walked out on me. “Bitch,” one of them called me once, spitting the words at my feet. After a few years in women’s health, just when I wondered if I should give up and work somewhere else, I met seventeen-year-old Lourdes, a tall, hazel-eyed beauty who came for her first exam. She barely spoke English, and her Spanish was too rapid-fire for me to follow. “Mas despacio,” I said, and she glared and hammered on, thrusting the edge of her hand at me when I didn’t understand. At that first visit, I discovered she had three sexually transmitted diseases— chlamydia, herpes, and a nasty case of trichomoniasis. Although Lourdes was furious when I told her about the infections, and even though we were hardly able to communicate, she kept coming back. At some visits I’d see that her thin arms were bruised—ragged patches in purple, red, and blue—but when I asked who was hurting her, she’d growl and show the whites...