Doctor's Orders, Featured, in-Training 10-Year Anniversary
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Abrasions, by Morgan Shier, MD

This April marked the 10-year anniversary of the founding of in-Training, and we invited all members of the in-Training family to contribute articles and other artistic works to celebrate our first decade as the premier online peer-reviewed publication by and for the medical student community.

Dr. Morgan Shier, MD is a family medicine physician in Colorado and contributes this article as one of our first in-Training writers in 2014 and a featured writer in our print book in-Training: Stories from Tomorrow’s Physicians.

Medical humanities: The study of the intersection of medicine and culture by way of writing, art, and beyond. Writing about my experiences in medicine and in life has, for some time now, been my way of processing the complexity that is inherent in the job of being a human and a physician. Here is a piece I wrote during this particularly challenging year of 2022. I am grateful for opportunities such as those provided by in-Training and in-House to share my experiences. 

My mother likes to tell the story of how, as a small child, I referred to the superficial wounds sustained in my first head-over-handlebars accident as an “abrasion.” I remember staring at my knee, fascinated by my body’s ability to heal itself. The sacred anatomy of wounds, atoms as spacious as galaxies, coalescing and woven with no instruction of my own to renew what had been lost. 

A 90-year-old female comes into my office for acute low back pain. She wears a T-shirt and high-quality tennis shoes. She is the primary caregiver for her adult son, who is disabled. One year ago, she lost her other son, who also lived with significant disabilities. She states, “My sons are the reason I keep going.” 

“She is the kind of mother we all deserve.” This is what I wish I could write in my progress note. 

I take the posture of listening, perched on a stool, eyes meeting her gaze a gentle distance away. Her son died in the nursing home. “Before COVID, I visited him every day. But in this most recent wave, I could not visit him in his final days. He bled out. Slowly. Alone.”

Her history reveals the sudden onset of low back pain while scrubbing the floor in her kitchen. She calls me “doctor” and I melt. “Doctor, I’ve never had pain like this before.”

On exam, she has exquisite tenderness, wincing at my feather-like touch to her low back. I send her for x-rays, and she declines my rare offer for something stronger than Tylenol. 

Soon after, her x-rays reveal a “fragility fracture” of the lumbar spine — a fracture that occurs with minimal or no trauma and is due to the inevitable breakdown of her thinning aging bones. I cannot help but think that sometimes a mother’s pain is so great that her bones break. 

Inherent in my job as a physician is to bear witness to pain. Whether it be the transition phase of an unmedicated labor or the waves of grief accompanying the loss of a loved one, I am privy to some of life’s most painful moments. This year, I’ve intimately danced with pain of my own, giving birth to my son with only warm bathwater for relief and grappling with the unusual, tragic, and very public disappearance of my father who was beloved in our community and who has yet to be found. 

My patient returns to my office after her x-rays, and I tell her we have an explanation for her pain. She verbalized understanding of the treatment plan and then asked me earnestly, “Doctor, how are you?” Instead of melting, I unravel.

This is not the first time I have been asked this question in this way today, nor will it be the last. There is a spectrum of “askers” from what feels like the morbidly curious to the genuinely concerned. My go-to response has been, “We are here to talk about you.” But this patient knew my father, and for a moment, we become bound by the experience of loss, a potent reminder that grief is the cost of the deepest love.

“I’m doing okay. Thank you for asking.” We stare at each other for a moment, and then both look away, trying to hold back the tears forming menisci on our lower lids. I reach for the tissue box to my left and hand her the box. It’s too late for us both, our masks quietly absorbing the moisture of our shared sorrow.

Most days, I can hold my grief at arm’s length, but there are days when I know surrender to grief is unavoidable. I am currently caring for a mother whose child died within the first week of life. We were pregnant at the same time last year. I had not seen her for nearly a year until recently, when she sought care for extreme fatigue and breathlessness. At her first visit, we reviewed her symptoms and devised a treatment plan. Then just before I left the exam room, she asked bravely, “Doctor, how is your baby?” Again, I unravel, the energy of grief taking me by my hand and gently guiding me back to my seat in front of her.

“He’s good. So, so good.”

“Do you want to see a picture of my baby?” 

Tears welling, “Yes, of course.”

She shows me a picture of her holding her baby, who is adorned in a beautiful white dress, and I’m not sure if the baby is alive in this picture, her eyes closed and lips so blue. 

“What was she like?” 

And in incredible detail, as such only a parent can provide, she tells me about her baby. Later, and alone in my office, I document the baby’s first, middle, and last names in her mother’s chart. My progress note is now a memorial to the baby’s short, sweet life. In that moment, grief’s presence surrounds me and holds me with the gravity of a weighted blanket and I feel its familiar vibration in my bones. I feel the loss of my patients’ children. I feel the loss of my father. I feel the deep exhaustion of full time employment, nursing a three-month-old and potty training a toddler. Through the rigidity of gritted teeth, a hardened jaw, and eyes squeezed shut, joy somehow finds its way to the aliveness and receptiveness of grief. I stay here for a moment and I am returned renewed by the transformation of our shared loss into something sacred.

I often wonder how my frequent encounters with grief will affect my children. Pregnant with my boy at the time my father went missing; he was bathed in the amniotic fluid containing the molecules of my sadness, confusion, and sometimes anger. And even now, when I see my father’s smile in his, the mirror of genetics transcends space and time, and I am humbled to my knees. My daughter, who was newly two years old at the time of my father’s disappearance, impressionable and connected to unseen worlds, regularly said, “Papa” and pointed to empty space. Instead of correcting her, we whispered to the empty space, how much we loved and missed him. 

We see how grief moves through us, holds us and breaks us, yet is light enough to where we can ascend from the depths of our despair, having woven ourselves more capable of embodying the exquisite parallel conditions of beauty and loss. Grief has the power to wake us up to what we have in common as one human race, and joy, a conscious coalescence of our diversity of experiences into personal and collective healing. Like clots blooming at bleeding edges of abrasions, grief reminds us of the extraordinary potential for growth and transformation in us all.

Image credit: Stethoscope by Rosmarie Voegtli licensed under CC BY 2.0.

Morgan Shier, MD Morgan Shier, MD (3 Posts)

Contributing Writer Emeritus

Ross University School of Medicine

Dr. Morgan Shier, MD is a family medicine physician in Colorado and was one of our first in-Training writers in 2014 and a featured writer in our print book in-Training: Stories from Tomorrow’s Physicians.