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A Piece of My Mind
December 21, 2018

We Are All the Same

Author Affiliations
  • 1Family Practice Center, Mifflintown, Pennsylvania
JAMA. Published online December 21, 2018. doi:10.1001/jama.2018.21366

As neighbors gathered around their Christmas trees, Mrs Martin worried about her newborn child. None of her seven other babies had been so disinterested in nursing and not a single one had been so limp and quiet. One week postpartum, she wrapped herself in a thick black shawl and trudged the half mile in the snow to my sister’s door to seek help.

My sister, a nurse, was surprised to see Mrs Martin. As part of the Old Order Mennonites, deeply faithful and private people, the Martin family denounced all things modern. They lived on a farm with no electricity or indoor plumbing. Visits to the doctor were few and far between, and modern medical care, even for childbirth, was simply not part of their culture. The baby boy had been delivered by a midwife who cleaned and weighed him. After laying him on his mother’s breast, she promptly packed her things to attend to another expectant mother. Hearing the panic in Mrs Martin’s plea for help, my sister immediately picked up the phone. Skipping the holiday greeting, she tersely told me, “Get your bag and come over here as soon as possible. The neighbor baby is very sick.”

As we set out that bright Christmas morning, I remember the feeling of peace that settled over the town as a light snow dusted the ground. Stepping into the modest yet spacious kitchen transported us to another era. My sister and I were greeted curiously by the seven older children in the family, all girls. Smiling shyly, they were dressed in plain handmade blue dresses and unadorned white head coverings. The entire family solemnly gathered around to watch as we conducted a brief examination of the infant on the kitchen table. The room was silent, no one spoke a word, and the child was alarmingly quiet. The only light in the room streamed in through large windows, enough to see that baby boy Laverne was very blue, dehydrated, and lethargic. I advised the stoic family that the baby needed urgent transport to the hospital. Mr Martin calmly argued that it was too far for their horse and buggy and that he couldn’t possibly find a driver to take them on Christmas Day. We debated calling an ambulance, but EMS in remote areas rely mostly on volunteers and summoning an ambulance on Christmas morning would not be easy or quick. Fearing for the child, we made the decision to transport him ourselves to the nearest tertiary care center, in an infant seat borrowed from my sister.

A few days later, little Laverne underwent surgery to correct transposition of the great vessels. My sister and her husband continued to transport the parents to and from the hospital as the child recovered. Realizing it was a rarity for a doctor and a nurse to perform a home visit on a holiday, the family was extremely grateful for our intervention. Without our insistence, they would not have sought medical care until circumstances were dire. A friendship developed that defied the cultural boundaries that previously separated us—my sister and I were the Martins’ bridge to the medical world.

A few years later, my husband and I peered anxiously at our newborn baby in the same hospital where little Laverne had undergone surgery. It was our turn to experience the life-altering news that our child had a severe congenital heart defect. Four hours into our daughter’s risky surgery, the door to the waiting room opened to the surprising arrival of the Martin family. We were unlikely friends brought together in a parents’ worst nightmare. To others, we must have been a strange sight as our two very different-appearing families huddled together for support. Our daughter’s future was in the hands of the same surgeon who offered their child a normal life and that gave us hope. That afternoon, we prayed that one day our children could play together as we reminisced about these hard times. Three days later our daughter died.

Eight years later, I still get asked about that Christmas day that I went out to see the sick baby. In my small clinic, I now care for many Mennonite and Amish children, some with rare genetic diseases. Most of these families came to my clinic by word of mouth. They refer to me by my first name, the dropped title of doctor a sign of reverence rather than disrespect. They ask about my family and deliver baked goods, homemade cards, and wedding invitations. The medical students who pass through my office are mystified by the unlikely friendships that I have cultivated with this group of patients. An Amish friend offers a simple explanation: “In our hearts, we are the same.” I hope the students carry forth this fundamental truth. It doesn’t matter if we drive a buggy or a car or if our home is modern or rustic. We all share a common humanity. Each of us navigates this life with fear, anxiety, happiness, and joy. We will all suffer disappointments and celebrate successes. We all love our children deeply. When a child is sick or dies, the tragedy strips everything down to the barest, most basic human emotions that reach across all cultural boundaries. We are all the same.

Today Laverne is a happy and healthy young boy. Though his family has moved to another state in search of less modern surroundings, we still receive letters from Mrs Martin. Each time she mentions our daughter by name—Abigail. I believe that it’s important to her to recognize and honor our child, an acknowledgment of how deeply grateful she is that her son survived. Mother to mother, she understands the burden of grief that I carry every day because it was her burden to carry as well. This beautiful circle of friendship and reciprocity endures two different outcomes: joy and grief.

It strikes me that so many of life’s moments are dichotomies of health and disease, life and death, joy and sorrow. As a family medicine physician, this mirrors my everyday life. I often leave one patient’s room after giving bad news and immediately enter the next room to see the happy parents of a newborn. Navigating the full spectrum of human emotion is simultaneously exhilarating and exhausting. There are days when I feel like a hero and others when I cannot do a thing right. On those days, I reflect upon the lesson I learned from baby Laverne. Connecting deeply through our shared humanity, no matter our differences, is one of the most precious gifts we offer and receive as physicians. We are all the same.

Section Editor: Preeti Malani, MD, MSJ, Associate Editor.
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Article Information

Corresponding Author: Mandy L. Maneval, MD, PhD, Family Practice Center, 2813 Industrial Park Rd, Mifflintown, PA 17059 (mlmaneval@geisinger.edu).

Published Online: December 21, 2018. doi:10.1001/jama.2018.21366

Conflict of Interest Disclosures: None were reported.

Additional Contributions: I thank the Martin family and my sister for granting permission to share this story.

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