Story Part II

The Story We Cannot See

For those that have not read Theo of Golden, do so. Quite an incredible read.

There is a moment in Theo of Golden when Allen Levi introduces us more deeply to Ellen, a woman whose circumstances make it easy for the world to place her into a category. Homeless. Poor. Troubled. Someone living at the margins.

But then we learn her story.

And suddenly that category becomes inadequate. Worse, inappropriate.

That is one of the quiet gifts of a beautifully told story. It forces us to remain with another human being long enough for our first judgment to become uncomfortable. For it to turn against us. For us to recoil against our prejudices.

I have experienced versions of this countless times in the newborn nursery.

A baby is born, and somewhere in the medical record is the story we have constructed about the mother. No permanent address. Limited prenatal care. Substance use. Domestic instability. Unemployed. Teenager. Medicaid. Social work involved.

These things matter. As physicians, we need to know them. They may tell us something important about the risks facing a newborn.

But they tell us remarkably little about love. Or lack there of.

I have walked into rooms where a mother's life outside the hospital was extraordinarily difficult, yet there she sat holding her newborn with the same wonder I have seen in mothers surrounded by every imaginable advantage.

She studies the baby's face.

Counts the fingers.

Asks whether the baby is eating enough.

Worries about a rash.

Pulls the blanket a little higher.

And sometimes, sitting beside that bassinet, the distinction between the woman with everything and the woman with almost nothing disappears.

They are mothers.

This does not romanticize poverty or homelessness. Quite the opposite. A child born into housing insecurity, violence, addiction, food insecurity, or profound financial stress faces very real biological and developmental risks. Epigenetics has proven this truth. We should not minimize them.

But neither should we confuse a mother's circumstances with her capacity to love her child.

There is an enormous difference between asking, "What is wrong with this woman?" and asking, "What happened in this woman's life that brought her here?"

The first question creates distance. Maybe unintentionally protecting us from our judgement.

The second creates curiosity. And curiosity is often the beginning of compassion. And compassion is sorely needed in this world. I had a parter physician for a few years before he retired, Tommy Carlton. Tommy lived the word of compassion. Always looking for the best where the worst may have been front and center. In Theo of Golden, Ellen needed a Tommy Carlton to see her and Theo became the Tommy.

Medicine is particularly vulnerable to losing this distinction because we necessarily compress human beings into summaries. A complicated life becomes a problem list. Years of adversity become three words in the social history. A frightened young woman becomes "poor prenatal care."

The shorthand is useful. The shorthand is also dangerous. A double edged sword to be sure.

Because nobody arrives in a newborn nursery at the beginning of her story.

Every mother who delivers a child brings another life into that room with her, her own. She brings the childhood she experienced, the people who loved her and the people who failed to, the opportunities she received and those she never had, the relationships she chose and sometimes the relationships from which she could not escape. Maybe she made a ton of poor decisions. Maybe not. Who are we to judge.

We usually know almost none of it.

Yet within hours of meeting her, we may believe we understand her.

Ellen's story reminds me how often we mistake the chapter we happen to witness for the entire book.

Perhaps this is one of the lessons babies can teach us.

A newborn arrives without résumé, address, income, education, political identity, mistakes, accomplishments, or reputation. We look at that child and see possibility. I do, every time.

The mother sitting beside the child deserves some measure of that same generosity.

Not naïveté. Not an abandonment of responsibility. Not pretending that difficult circumstances do not matter.

Simply humility.

The recognition that the person in front of us possesses a story larger than the portion we have been allowed to see.

After years in newborn nurseries, I have become increasingly convinced that one of the most important questions we can carry into medicine, and perhaps into life, is remarkably simple:

What don't I know about this person's story?

Because very often, that is where their humanity is waiting for us.

P.S. I am not suggesting, by any stretch, that each person is not ultimately responsible for the choices they make and the life they build. Quite the contrary. I believe that through love, belief, and support, we can help people move toward responsibility. To recognize that they can choose differently, choose to love themselves, and in doing so, learn to more fully love and care for a child.

That shift will not happen every time. I know that. I am wide-eyed about that reality. Failure will happen. But I remain committed to being part of as many love-induced shifts in choice as I possibly can.

Because at the end of the day, that precious child deserves it. And so does her mother.

We cannot guarantee the outcome. But we can keep choosing love and creating the conditions in which someone else might choose it, too.

Dr. M