How Could I Help this Patient?

MARCH 20, 2017
Diana Farid, MD, MPH
Editor’s note:
Was it really medical help this couple needed? Now a primary care physician at a student health center at Stanford University, in a prior practice, Diana Farid, MD, was asked by an obstetrician colleague to help with a troubling case. What she saw inspired her poem “Offline.”

by Diana Farid MD, MPH
an online meeting
an offline feeling
moved you across oceans
marriage tied your innocence
to a culture’s delusions
draped in duty’s garments
you eighteen and tangled
in your want for freedom
he is forty and some
no one ever in you
and he says he cannot
brings you to the OB
she will get you pregnant
instead she called on me
“Would you be her primary?”
I also have an eastern name
“Do you have time today?”
I met you, and him,
both in the exam room
my hand showed him out
so we could speak alone
he stood hesitant
in the hall,
like a spider guarding prey,
then on the web
began to crawl
to the waiting room,
in the hold
of his knots
sufficiently assured
you live with him
and his mother
allowed outside with him,
or his brother
I recommended frequent visits
full physical, blood tests, vaccines
anticipatory guidance,
and more counseling
complete review of systems:
“What is love, our purpose?”
you didn’t tolerate a pelvic exam
neither did I
no evidence of abuse
you think he loves you
believe his impotence
his med list says Viagra
tries to impregnate you
with a turkey baster
each barren period
amplifies his anger
rarely out of your room
shouted to every chore
only shame would greet you
if you returned home
answering service calls
during my vacation
told them to connect you
if you ever asked
I spoke to the shelter
checked on your address
you will wait outside
for the car they have sent
“call the human rights attorneys”
I repeatedly say
I haven’t heard from you though
ever since that day

Dr. Farid is a clinical instructor in the Department of Medicine and Staff Physician at Vaden Student Health Center at Stanford University. She has worked in Honduras, Ukraine, Malaysia, and China and cared for patients at the Los Angeles Free Clinic. Dr. Farid is an affiliated faculty member at Stanford's Medicine and the Muse program in bioethics and film, as well as a poet and children’s picture book author. She tweets @artelixer.

MD Magazine asked her for background on the case that inspired “Offline.”

Dr. Farid: I had just returned to work as a family physician after a maternity leave, when I was asked by an obstetrician colleague to see a young woman in clinic. She had just left the obstetrician’s office where she and her husband had asked for help getting pregnant. My colleague said she couldn’t help. She felt something was off about the couple, triggered by a large age difference, lack of any history of sexual contact between them, and that they married at their first meeting. Perhaps as her primary care doctor I could help the patient by establishing a relationship with her, make sure her basic health care needs were addressed, and determine if there was a real need for medical assistance with fertility.

 The patient was 18, had just arrived to the United States from another country and met her husband through an online dating website. She had never had intercourse and the couple had not even tried because her husband told her he couldn’t.  Neither of us knew with certainty why, it may have been due to erectile dysfunction. In the course of my visits with her, it became clear that she was a captive of her husband, that her value was based on her ability to have children, and going back to her home country was not an option for her. 

In contrast, I was a working mom, pumping between visits as my baby was still breastfeeding, am the daughter of a female OBGYN who had to flee her own country because of religious and gender based oppression, and majored in Peace Studies at Berkeley. Though my patient and I both had names with middle-eastern origins, our similarities ended there.

As her physician, I had to confront questions like: “What is love? What is the purpose of marriage? Is it OK that her definition is different than mine?  How can I help her keep her body safe, her mind safe, her spirit safe? How do I keep her coming back for visits? How do I find social and legal help for someone like her, whose phone conversations are listened to, who is only allowed out of the house escorted, who has no money, no friends and no relatives in the same city or even country?

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