“Sister, if you tell me there is nothing to worry about, then I will stop worrying”
The incongruity of the situation was astounding.
What was the worry? It was an absolute lymphocyte count of 3.8 with the upper limit of normal at 3.1 He had seen the result on the patient portal, that arm of the electronic medical record which would transform the patient-physician relationship allowing the “client” to participate fully in this “transaction.” He had noted that number, along with my brief explanation that I had crafted with just this possible outcome in mind (“We can recheck this at your next appointment. We don’t need to do anything about it now.”) — and here he was in less than a week for an acute visit, having armed himself with pages of internet searches related to “lymphocytes high.”
And who was this man?
He was familiar with being armed — not with irrelevant, not-so-medical web results but with guns and ammunition. In his homeland he had been a Peshmerga fighter, the military group of northern Iraqis famed today as the ground force staving off ISIS. He had served as a translator for the American forces in the Middle East, and now he and his family were here as refugees, enjoying peace and security where his four daughters could grow up and be educated.
And he could even articulate it.
“With open gunfire in the streets, hand-to-hand combat, searching out the enemy in abandoned buildings — I was never afraid. And now you tell me the lymphocytes are elevated and my anxiety is sky high.”
I wasn’t surprised. When he first became my patient, he was on several psychiatric medications and was being seen by mental health experts for diagnoses that included major depression, generalized anxiety disorder, and post traumatic stress disorder. He had a pulmonologist, neurologist, urologist, gastroenterologist, and rheumatologist for a wide array of medical conditions which were identified more by symptoms than by any tissue diagnosis. I suspect most internists dread seeing a patient with this constellation of findings in his past medical history.
I know I do.
He had insurance. So – why not? Farm him off to another specialist. I could just send him to a hematologist, and add to the list.
But what did he really need today, just like that first day I had seen him three years earlier?
Between that first visit and now he was off all antidepressants and sleep meds and anxiolytics. I was never really sure when it had happened, but he had decided that he needed to stop seeing the psychiatrists and psychologists who were medicating him as he continued to dwell on the past.
And he had to move on. So he did. On his own, it seemed.
And he was doing well. They had moved into a new house. He was talking about getting a job, ready to leave behind his designated disability diagnosis.
“Do you remember the story I told you about stress?” I asked him.
He did, he said. And he recited it back to me. If you run into a bear, your heart races, you start sweating, your stomach hurts – all the stress responses. But if you happen across a little bunny – none of that.
“And?” I asked.
He looked blank.
“What was the rest of the story?” I prompted him.
He shook his head. He didn’t remember it.
I laughed. “It’s the most important part!”
He looked at me still wide-eyed with agitation.
“It’s that sometimes what looks like a bear really isn’t a bear. It’s only a bunny. And we have to work with our thinking to get it right.”
His muscles relaxed. The edge in his voice softened. He understood.
And he trusted me.
It is a quality we must cultivate if we are to receive mercy. Trust. We must believe that the other person wants my good. If not, how would it be possible that the other could be merciful to me?
This middle-eastern, Muslim man trusted that his American, Catholic, woman doctor would not mislead him. Would not put him in harm’s way. Would not simply abandon him to another specialist.
And so he could receive the mercy that was offered to him. The assurance that his wife would not be widowed, his children not orphaned, because he was not going to die of a lymphocyte count of 3.8
In the Year of Mercy, we must know that to receive the mercy of God, we, too, must start by putting our trust in Him. If you tell me there is nothing to worry about, then I will stop worrying.
And that is precisely what He says. Over and over again. Fear not. I am with you always. Be not afraid.