Push.

*Names, details, etc. changed to protect anonymity. You know what's up.

"You got to push. 

You got to fight 'cause you might be all somebody got."

~ Ms. Nagle

We knocked on the door to her room and she summoned us to come inside. My hand extended and my mouth was moving before I could even think about what was coming out it.

"Hello there, ma'am!" 

Greeting the patients I see with the residents had become such a consistent part of my day that it was almost like a reflex. I realized that our hands were touching before I could even register her response.

"Ooooowwwww!" 

Her eyes squeezed shut and her lips pressed together in a tight line. She didn't reciprocate the handshake--instead she winced and drew that hand back. 

I felt terrible.

"I'm so sorry!" 

This, too, was somewhat reflexive but she seemed to appreciate my apology. I rubbed my forehead with the heel of my hand and shook my head. "Sorry about that. Your doctor just told me that you'd hurt your wrist. I apologize for not paying attention." 

"It's okay," she said with a polite smile. She wanted me to believe her so she repeated it. "It's okay."  Something about her eyes looked troubled to me. It was hard to put my finger on it. A wave of discontent ran through my body. Was everything okay?

Hmmmm.

I quickly gave her a once over. She was dressed in a fancy denim outfit adorned with shiny studs long the edges. Her hair was slicked into a high pony tail erupting with synthetic hair in perfect ringlets. The entire look was a bit. .  . .. . young -- but she was owning the look and seemed quite put together. Her appearance was enough to reassure me; I flicked off that "funny feeling." 

Back to business.

"I heard that you fell on your wrist? What happened?" I was already getting to the meat and potatoes of the visit but then I realized that I'd skipped something. Like an iPhone, I autocorrected myself. "Ugghh! Ms. Nagle, please forgive me. My name is Dr Manning. I'm the senior doctor working in the clinic with your doctor today." I cleared my throat and then did my best to build some rapport. "First I try to break your hand, then I get all in your business without even introducing myself!" She turned the right side of her mouth upward to acknowledge that she was okay with that oversight, too. At least that's how it seemed. "So this wrist. . . tell me about it."

"My wrist? I fell on it." 

I stepped back and gave it a good look. It was puffy from her hand clear to her forearm. All of the bony architecture was distorted and she guarded it gingerly. "Wow, it's pretty swollen. What were you doing when you fell?"

"Beg pardon?" Her defensive tone caught me off guard. Again, that undercurrent went through me. I didn't know what to make of it.

"Oh, I'm sorry. I'm just nosy like that." I nervously laughed and glanced at the resident. He had already told me the entire story but again--reflexively--I like getting a piece of the story told directly to me by the patient. "I heard that you slipped, right?" 

"Yes. Slipped." I caught her giving me the tiniest of eyerolls.

"Okay." I nodded and instructed myself to slow down. No more reflexive moves. "Just a stumble? I'm the queen of left feet so I can surely relate to that!" 

She looked irritated with me. "I slipped. I fell on it. Like I said."  

The resident sensed some mounting tension and jumped in. "She had it x-rayed in the ER over the weekend. Just a bad sprain but no fracture." 

"Oh. Okay. I was just. . .um. . okay." I stopped there and backed off. That uneasiness kept growing and I still couldn't tell why. Fearing that any more pushing would get me cursed out, I left it alone.

I moved past her wrist complaint and got on to her blood pressure and weight. She also had an itchy rash on her back that my resident wanted me to double check. The rash appeared to be some mild eczema from using the wrong soaps and too-hot showers, so we talked about all of that, too. Finally, my part as the attending physican had run its course. 

"Okay, then. . . it was nice meeting you, Ms. Nagle." I smiled and started to reach for her hand again. Before I could make the same mistake twice, I remembered my earlier blunder. Flattening my palm, I changed that initial gesture to a tight salute. "I hope you feel better, okay?"

She gave me a tight-lipped smile and thanked me in an almost inaudible voice.. A complex expression washed over her face as I reached for the door knob. I felt that same uneasiness gnawing at the lining of my stomach. . .more and more. . . .gnawing and gnawing. I knew that there was a stone that had been left unturned. 

"Ms. Nagle?"

She raised her eyebrows but her eyes pierced me with their intimidating gaze. I felt my chest tighten but took a deep breath and decided to turn that rock right over the best I could.

"Ms. Nagle, you slipped and fell. . . .I need to know. . . that you're safe. Are you. . . safe?"

Those lofty brows furrowed down and challenged me further. "Am I safe?"

"Yes, ma'am. I know it seems like a crazy question but I just want to make sure I'm not missing anything, I wanted to make sure that nobody was hitting you or harming you or. . . . .I don't know."

She just looked at me and didn't speak. I couldn't tell if she was offended or deciding whether she'd answer me or both. Finally, she spoke. 

"Yes. That is a crazy question. No. You ain't missing nothing. Okay? It was good meeting you. . .Dr. Manning." 

And that was that. I slipped out of the room with my tail between my legs and didn't even look over my shoulder when I left. 

That was almost two years ago. I thought of her often and hoped that she was okay. I looked her up in the computer periodically and saw that she was still seeing us. Eventually, I told myself that I was being crazy and stopped checking.

Some part of me still wondered if and hoped she was safe.

 **

Last week.

I was surprised to walk into a room the other day and find her sitting there waiting. It had been nearly two years since that visit for her wrist and now she was with a completely different resident. She smiled big and wide and genuine the moment she saw me. 

"I remember you!" she said.

"I remember you, too."  

I decided to tread softly because I did remember her. I always thought of her and wondered what ever happened. It was good to see her here and on this day she looked well. Much better than she had two years before. 

I kept things light and reviewed parts of her physical exam. I repeated the plan that her new resident doctor had already discussed with me and reinforced a few teaching points. There really wasn't anything active or of great concern so I prepared to leave. When I reached out to shake her hand, she closed her fingers around my hand and gripped down hard. Intentional. Telling.

"Your wrist is better," I said as our eyes locked. Up went those eyebrows again. She bit the inside of her cheek and offered me a tiny head nod. Up and down. Up and down. A tiny, telling motion. 

"I wasn't safe, you know." Her eyes were still on mine and her fingers were still pressing into the back of my hand. 

"Aaaaah." I shook my head hard. "You weren't? I was always afraid of that." My voice was hushed and defeated; I internally kicked myself.

"You need to be even more afraid next time, okay? I wasn't safe." 

I felt my face wash over in shame. My eyes began to prickle with tears and some tiny person inside of my head was screaming at the top of her lungs waving her arms all around. 

"I'm sorry. . . .  Damn. What. . .what happened?" 

Now my eyes were watering and I was blinking like crazy. My resident looked totally confused--almost like when somebody discovers that two alleged strangers being introduced aren't strangers at all. At all. 

"What happened? Aaaaah. It's all behind me, Dr. Manning. Just know that I'm safe now. I'm safe, okay?"

My nostrils flared and I sucked in a big breath of air. I gave her back that same quick nod while mumbling, "Okay."

Ms. Nagle reached out and covered my hand with her other hand and spoke words that pushed some of those tears onto my cheeks. "You GOT to listen to your spirit, okay? Don't let somebody being afraid back you down like that. You got to PUSH. You got to fight 'cause you might be all somebody got." I pulled my hand back gently and swept my cheek with my fingertips. I caught the resident staring at our interaction and felt a little embarrassed for my emotion. Still. I couldn't pull back those tears once they started. 

Especially once hers started coming, too. 

"Your spirit was speaking to you that day. Something wasn't right in your soul when you saw me and somehow you discerned that I wasn't okay. . . that I wasn't safe. I wasn't safe. I was getting my behind kicked and I was scared and confused and not knowing how to get out of that situation. That man had grabbed my wrist and twisted it bad that day. I was telling myself, 'I'm too old for this. I ain't no twenty five year old girl. I'm fifty something years old.' Plus it had been bad for a long time. I was so shocked when you asked me flat out like that. . .was I safe. . . .I just. . .I didn't know what to say."

"Damn. I should have pushed."

"You got to push. You got to. I know that stayed on your heart when you left that room. I jest know it did."  

I closed my eyes and nodded yet again.

Yes. It did. It stayed. On my heart. I remembered myself holding onto that scrap of paper with her medical record number for all those months. Yes. She was on my heart.

I gave my eyes another hard wipe and sighed. With a big smile I reached for Ms. Nagle's hands. She met both of mine with hers and laced her fingers in my own. My eyes got hot again and I blinked to get them back to normal. 

"Thank you, Ms. Nagle."

"Thank YOU," she replied firmly. "And remember. . . you got to PUSH."

"I promise. Next time, I promise that I will."

"In all parts of your life. Not just here. You know some people supposed to be there to encourage. They 'sposed to listen and use that gift and know when and how to push."

"Yes, ma'am."  She was preaching now, so I knew to listen to her every word. This time I didn't want to miss a thing.

Ms. Nagle narrowed her eyes. "Even when they push you back--listen to your spirit and don't be scared, okay? Push." 

She clamped down on both of my hands and pushed out against them to make her point. And I got it.

"You got to push. You got to fight 'cause you might be all somebody got."

~ Ms. Nagle

Thank you, Ms. Nagle. And I really am glad that your wrist is better.

***

Happy Tuesday. And I hope Ms. Nagle's good word reminds you to push, too. Even when they push you back.