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A Piece of My Mind
January 9, 2018

She Smiled as She Walked Away

Author Affiliations
  • 1Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA. 2018;319(2):121-122. doi:10.1001/jama.2017.19760

The muscles of my back unclenched one by one as I sank down into my chair. It was barely lunchtime and already the day felt as though it had exceeded its time in the hot Central Asian sun. Crunching footsteps outside signaled that my respite was to be short lived. My partner medic’s apologetic face poked around the corner—another patient required my attention.

A woman from the nearby village was requesting medical care, reporting that she had spilled boiling tea on herself. Because of the deeply ingrained gender barrier, my partner’s examination had been limited to the realm of subjective questioning. In their extreme modesty, the local women were particularly reticent to bare any portion of their bodies, even in the case of a medical examination. Understanding that cultural mores prevented my male colleague from providing the care this patient needed, he came to find me. So I found myself being introduced to a kind, quiet woman with henna-stained hands. The role of patient and caregiver was established through an odd combination of hand gestures, fragmented language, and smiles. As she lifted the hem of her dress slightly, I expected large, organically shaped burns or a splatter pattern consistent with an accidental scalding injury. What I saw instead sent chills through my body and tied my stomach in knots—a perfect ring of blisters and singed skin.