At my first view of her the lightness of a COB visit vanished. She looked unwashed, a little stinky - although I couldn't smell her - and rough. I picked up the clean new chart that belonged to her and shuffled through the paperwork, organizing it as best I could so as to focus on her in the interview, not my many forms. She would need it.
After a decade in healthcare it's hard for a patient's story to surprise me, but I'm often surprised by how much I still connect with any patient whom I can sit with and listen to. I'm a slow interviewer. I lose track of my prenatal form flow and listen: To her grief at the pregnancy, some poor choices, the consequences she was working through. To a resolution to do better and an oblique request for absolution. I also listened for what I didn't hear: excitement about the life growing inside her. I doubt she sees much in this world to be excited about.
But I left the room and passed her off to the OB with a sense of hope - and admiration. She came. She told me as much as she did and she listened to my response. That's where she's at, and I hope I met her there.
PS I don't see many patients after this first visit. I haven't seen this woman again and, sadly, I can't even remember her name. But I think of her from time to time and I hope for her and her baby.