The Phoenix: A 20-Year Patient-Doctor Journey

• physician narrative
• patient narrative
• doctor-patient relationship
• chronic pain syndrome
• sexual abuse

The phoenix—the legendary firebird in Greek mythology as well as in the folk stories of other cultures—dies in a show of flame and combustion, only to rise again from its own ashes. It has become a symbol of resurrection and in some versions its tears can heal. In western culture, the term “phoenix” may be used to describe people who rise after adversity.

Dearest Dana,

You are a phoenix. Many times I have written about you. It began with letters to colleagues and medical advisors, in the acceptable disconnected medical jargon: age…marital status....complains of the following symptoms…test results indicate…diagnosis…

As I browse through your file I am disturbed by the unemotional language, speaking of you in third person, as a human object with a myriad of unexplained symptoms. Afterwards, I spoke about you (changing all identifying features) in my Balint group for family physicians, where I could share my concerns and frustrations regarding your care in a safe, empathic, and nonjudgmental environment. I shared that your complaints at age 15, 20, 30, and 35 were atypical of a young woman your age. I told of how you wouldn’t agree to psychological intervention as an adjunct to the medical care for the severe physical symptoms you suffered from since we’d first met two decades ago. I told how you evoked empathy and respect despite the barrage of incurable symptoms.

At a certain point you were diagnosed with fibromyalgia, characterized by extensive pain and sleep and mood disorders. Its cause is unknown and some doctors find it a baffling and frustrating illness to address. Some may belittle it or even discount it completely.

I firmly believed in your desire to heal: for your loved ones, your children, and yourself. I denied any suspicion of secondary gain to receive monetary compensation or attention. You always seemed to have something or someone to live and function for, even during times of complete collapse.

As I cared for you, I learned about the many lessons you endured: your father’s death while you were a teenager and your mother’s suffering from a complex mixture of physical and emotional problems. You came from a poor family that always maintained its self-respect. You married your first sweetheart, yet he too died a tragic untimely death, leaving you with a year-old infant. You had many good reasons to be depressed. I assumed that, despite all that I knew, it was still only the tip of the iceberg of your pain. As an experienced physician, I thought perhaps time would eventually unravel the many layers beneath the surface of your story. One of the benefits of caring for patients for what is now over two decades, is that a more comprehensive understanding of a patient’s symptoms emerges only after many years. Such continuity of care also enables a deep bond of trust to develop between patient and doctor, which also helps open the door to deeper sharing, as indeed transpired between us.

As part of my efforts to understand the inexplicable peripheral blindness that plagued you for the last decade, I wrote a story in which I related to the blindness as a metaphor, a way you unconsciously chose to avoid looking to the sides, maintaining a steadfast gaze into the future¹. I thought the past and present were too painful; hence, you focused on the future. I failed to relate to the blindness itself—all that you wish to avoid for it is too horrible. In short, I wrote about the small flashlight you lit under the blanket and evaded, together with you, the giant monster in the room.

The story lay hidden in my desk for a decade. I didn’t show it to others and never told you I wrote it. I was embarrassed at my own clumsy efforts to piece together the puzzle of your life and thought I was mistaken in my interpretation. I wrote it for my own purposes: to relieve some of the heartache in carrying your story and to attempt to create a cohesive narrative with a beginning, middle, and end. Writing your story served my own need for meaning—for you and for my professional life.

Two years ago I received terrible news: a man who was under my medical care was exposed as a serial pedophile. He had raped many young girls, mostly in his family, for years, in one of the villages in which I work. After the first courageous woman spoke out, additional women also began to testify, to the investigators, the court, and the media, about the cheerful uncle who had destroyed their bodies and souls. I was shocked at the news: as a doctor, as a mother, and as a human. I wondered if there was any way someone could have saved those young girls—their mothers, perhaps an older sister? The secret remained hidden for over 20 years, and nobody guessed—not the family, teachers, social workers, doctors, or nurses.

Later I learned that you too were one of his victims. You spoke out in court, and in my office. Despite the damage he inflicted upon you, you survived. You left home for boarding school, and regained confidence in love and humanity, marrying a man you loved and bringing forth new life. You managed all of this despite severe and persistent anxiety. Yet your body refused to remain silent, expressing the pain you never uttered. The conviction and incarceration of the rapist did not bring you any relief. Your body violently reacted to the horrible secret it contained: back pain and arthritis, vertigo, weight gain, metabolic syndrome…

At least now we could openly speak of the connection between your symptoms and your traumatic past. Finally, I could stop imagining and inventing your story; I could finally hear you, Dana. I shared with you the story I wrote about you and my attempts to understand you. You surprised me by revealing that you too write little “notes” —beautiful lyrical pieces, some of which you shared with me that very day. And, in your typical heroic manner, agreed to share some of your writing.

The House on the Hill

The house on the hill

where it all began...

where it all ended...

childhood, innocence, the piercing cry

the sadness, the silence, the atrocious pain

the almost silent scream

that no one heard.

Just one more moment, she convinces herself

and closes her eyes

swallows her saliva

and with it the pain that racks her body

and refuses to let go.

One more moment she promises herself

and then you can go somewhere safe

to the house and room that

bears no memory of

what happened.

Over time the young girl grew

and became a woman and

every time she passes by

she looks

and never for a moment

can she forget the hours...

the days.,.the months and the years...

there in the house on the hill.

the familiar house.

And she smiles,

trying all the time

to be the best she can

and to continue with her life...

to shed all the layers of memories

that prevent her from

moving forward and forgetting...

everything that remains etched

on her tiny and tortured soul

everything that happened

in that house on the hill,

in that familiar house.

And the light is still on there

like it was years ago.

and there is life inside

and she stands there in the darkness

and glances backwards with a bitter smil

trying to not remember.

She wants to move onwards

towards happiness

but at every stage she stops

and looks backwards...

and silently questions

what would have happened

had she been an ordinary child.

She struggles as a tear flows down,

she stands upright and sadly smiles...

I shall overcome, she promises herself

hoping she will never remember

or perhaps will forget just a little

the house on the hill….

the familiar house.

I Am a Woman

I am a woman!

Look at me please...

sometimes soft, sometimes tough

I am a woman.

Sometimes asking or demanding,

teeth chattering.

I am a woman.

I am both open and hidden,

vulnerable and veiled,

a lioness and weak,

please look at me.

I am a wife and a mother

and if you look for a moment

within

you will see me

whispering in my softness,

longing and asking.

I stand brazenly without shame.

Look at me.

I am a woman.

On Her Birthday

On her birthday

the trees will dance

in the suns rays,

with the leaves

that now adorn the earth

after the cold winter.

In the river of her childhood

many memories remain

choked

in a flood

of sadness.

She always preferred silence...

from which she spun

one

dress

after

another

with

a needle

and

thread.

I was and remain mesmerized by your writing: about the home in which you were unprotected, about how you were abused, and about how you still knew how to give and receive love and even love yourself. Your words are as clear as your gaze, gentle and powerful. They bear witness to how you raised yourself like the phoenix from your own ashes. Through our correspondence our bond deepened. I shared my amazement at your strengths and talents; you shared your inner world. “You are one of the pillars of my success,” you wrote me at one point.

My dear Dana,

It has taken nearly two decades to reveal your full story, as the truth indeed has its own pace. Thank you for trusting me. Finally, we can now address both your body and your soul. I have also discovered that despite the many differences between us—in age, profession, background, culture

• Received for publication April 21, 2019.
• Revision received June 24, 2019.
• Accepted for publication July 17, 2019.

• © 2020 Annals of Family Medicine, Inc.