Section 2 > Exercise 7 > Physician-Patient Boundaries
Read the following excerpt from Nadine Gordimer's novel,The Pickup and answer the discussion questions that follow.
Nadine Gordiner, The Pick-Up (excerpt)
Dr. Archibald Charles Summers has been in medical practice for the best part of a half a century.
After 41 years your professional ethics are immutable, like love; you’ve always lived by them.
For 41 years the boundless opportunities of the gynecologist were there, his harem of beauties passed literally through his hands. That afternoon as every afternoon in consulting hours the anteroom where they waited on his summons was full. His girls. On this day one or two among them were new acquisitions, no doubt brought there by the faith of others in the understanding and healing powers of their 'Archie'. The newcomers were identifiable because they were busy under instruction from the serene and elegant Farida at Reception, filling in forms with personal details. Farida remembers well—trust her efficiency—the two women, on the kind coming along with a first pregnancy, and the other, age on her form set down as 35, a youthful-looking woman—well-endowed in every sense (Farida's image of her, later), expensive clothes and rings, breasts soft as marshmallows falling together in the scoop neck of her dress as she leaned to write. Her appointment was early on the list and she did not have to wait long. Farida knows all kinds: this was one of those who feign not to be aware that there is anyone else, any woman other than herself, in the space around that self. She had not brought a book with her, as the intellectuals do, nor did she delve into her handbag or pick up and toss aside one magazine after another, as others do. One of the tense and haughty ones, plenty on their minds.
When shown into the doctor's room she greeted him as with relief at getting away to find herself with an equal. She sat back confidently in the chair across from his desk furnished with friendly tokens of patients gratitude, malachite paperweight, embossed diary, clutch of gilt and silver pens, miniature calculator, two statuettes, copies of some god and goddess—he was at once interrupted by an urgent phone call, and she picked up one of the sacred objects and turned it, smiling. As he ended the call with a gesture of apology, she replaced the god. –Like the good Doctor Freud you enjoy having ancient art around you.—
—They are nice, aren't they. The Greek period in Egypt, I'm told.—
—Well, I'm sure they're a necessary change from the present with the troubles of people like me.—
He recognized then, at once, that she was not a woman who must be approached with small talk. —Now let's hear what the trouble is.— He was also smiling slightly as he glanced through the form bearing her statistics and medical history.
—I'm in the middle of a divorce—and you know how that is, the lawyer says if I want the settlement I'm entitled to I shouldn't be found to be having anyone else—if my husband's lawyers knew there was another man…—
—I understand. Yes, that generally would be the case.—
—And now. I have a problem.—
—There is another man. Yes. That's also generally the case. You are—let's see—thirty-five. It is a restless age for women. If only men would understand that, there wouldn't be so many divorces.—
They both laugh.
—So you'll know what's coming next, Doctor. I think I'm pregnant. God knows how it happened, I'm careful. The usual symptom, no period for two months. I thought the first miss was, what does everyone blame everything on, now—stress. I've got a new job—credit manager in a multinational company and now there's this. I've done that urine test thing—negative, but I don't trust it.—
—Any children of your marriage?—
—No. An abortion, five years ago. I'm not the motherly type, that was one of the things—many things—wrong in the marriage.—
—So if we do find you are pregnant, you don't want the child. Of your lover. I must ask you, you know. Your answer affects what we might be discussing for you, after.—
—No child. No. He won't know either. Anyway, seems it's over with him. I don't want any complications. I didn't think you would be one of those doctors who are disapproving about abortion.—
And so this woman is one of the unhappy ones. She thinks she's a bad woman, they all do, the girls, when they want an abortion for her kind of reason, they sound cocky but they feel they are unnatural, their mother and grandmother would tell them so, and they still hears the echo. —I'm not, my dear. An unwanted life hasn't much chance of having a life worth living. But I have to have some assurance of the option, for you. Now come, let's see.—
It must have been this way.
She undressed in the cubicle with the shapeless gowns hung ready to be discreet over obligatory nakedness presented to the doctor, a ritual process very different from, although the consequence of, being undressed by a lover. The nurse, calling her 'darling' and humming to herself, led her to the examining room, Archie's inner chamber, windowlessly private; the nurse withdrew; she lay on the crisp white sheet over a kind of steel bed and looked at the wash-basin with its taps that could be managed by the elbows, and the powdered latex gloves, pots of unguents and a gleaming long instrument on a small shelf.
The doctor entered by another door and closed it quietly behind him, gave her a reassuring nod and went about his priestly preparations with the calm that meant so much to his girls, all of them treated alike with the same respect for their feelings at the surrender of their bodies without intimacy. He opened the gown, placed a linen towel at the belly down over the pubis so that she would not have the embarrassment of gazing at his gloved hand first opening her up, then pressing what must be the long fingers of his warm hand she could not see all the way to touch some resistance inside her; that must be the womb, the centre of life whose holiness has so long been his mission. The hand caused momentary sensation, a vague ache, like sadness; the hand, the touch—all was withdrawn.
He removed the glove, turned to her with the face of good news. —You are not pregnant.—
He saw her draw a great breath and tilt back her head. His girls. If men knew what crisis women face.
—But all isn't quite as it should be with you, my dear, inside. Let me explain. He was covering her completely with the sides of the gown drawn together as he removed the towel. Then he perched on the edge of the steel bed in his customary way, one leg braced to the floor, the other bent at the knee, to comfort his anxious girls by his presence, there for them, no matter how grave what he had to tell them might be. And he laid the palm of this hand reassuringly on the stuff of the gown covering her hip as he told her—It's nothing to worry about at present, but your uterus is retroverted, that means it's tipped back, out of place—you don't complain of back-ache, do you?—
—No. No, no.—
—Then we'll let it be. If you start to have aches and pains, we'll do something about it.— She's an intelligent woman, she'll enjoy sharing one of his old army quips, all his girls have heard it. —Don't ask to see the brigadier unless he sends for you.—
She grasped his hand where it had alighted on her and pressed it. He gently but firmly withdrew, he was accustomed to these impulsive moments of gratitude, women indeed suffer much stress.
Back at his desk with the patient before him in her elegant clothes, the outfit of a woman who thinks of herself, presents herself, and not without good reason, as good-looking, he wrote the usual prescription for amenorrhea and dismissed her with a word of caution, half-admonitory, half-joking—But don't rely on that womb of yours—take your daily pill, eh.—
—I don't need to come back?—
—You're a healthy woman. Just take care of yourself. That's what I tell all my girls and hope they'll listen.—
—All. —A wry pull of the mouth. —Oh. —She picked up the little god, put it down. —You don't think I should see you again. Anyway.—
His girls. As their mentor, sometimes their needs are beyond what he can give. Then their time is up—time for the next one—he kindly indicates this by rising and coming round from his desk to shake their hands: on this day, with this woman, as usual.
That weekend he and his wife Sharon indulged themselves in their love of both music and country walks at a nearby resort where a chamber trio gave an all-Mozart Sunday concert. When he came from his morning hospital round to his consulting rooms on Monday a summons was served on him to appear in court on a charge of sexual harassment. His new patient was the plaintiff.
Discussion Questions
- Did the doctor cross any boundaries?
- The patient sues the doctor. Why? How would you feel?
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Link to description of borderline personality disorder |
