On one of my last days of community pediatrics, I saw a 4-year-old Tamil girl who came in for a well-child check-up with her parents. I first encountered her in the hallway, where she was getting her vision screening. The entire thing was a tense affair, because she was having some trouble reading the chart, much to the chagrin of her parents. "Try the chart with the letters," they said, "She knows her letters." Dad was helping her cover up one of her eyes at a time because she kept peeking, the way children are wont to do. Mom came up to the chart and was pointing at letters along with the medical assistant, hoping that maybe the child was just confused by someone else's pointing. Yet the child's difficulty with vision persisted. Mom told Dad not to cover the child's eye for her, to let her do it herself. Dad kept saying, "but she's peeking!" Meanwhile, no one but me seems to notice that the little girl's eyes are welling up and she is becoming increasingly agitated by her parents' all-too-evident disappointment.
By the time my attending and I walked into the patient room after all her screening was completed, the little girl had been frankly crying and was wiping tears off her face. My attending asked why she was upset, and Mom admitted that she had been scolding her for her bad vision, that hadn't Mommy and Daddy told her not to sit so close to the television? But she had done it even when they told her not to, and now her vision was spoiled, and it was all her own doing.
I was so distressed by this whole thing. It reminded me forcibly of times I've gone through difficult situations and my parents, instead of comforting me when it was obvious I needed comforting, instead pointed out the mistakes I had made that had resulted in whatever pain I was feeling. (Case in point: when I accidentally backed into a parked car one night in my junior year of high school, setting off a cascade of events including police involvement, which was completely out of proportion to the tiny scratches my car had made on the victim's car, which was already heavily dented, I came home sobbing because I felt so terrified about having my first "accident." My mom's response? "I told you not to go out to that party tonight! Why did you drive home so late? Why were you on that street anyway? Who told you to give your friend a ride home? You shouldn't have done all those things," and, the implication was, your tears can only be blamed on yourself.)
This tendency to blame instead of comfort, to point out wrongs instead of pointing out solutions, is a terrible pattern my parents have demonstrated again and again. I suspect it's common to a lot of immigrant families, especially Asian ones. I wanted so badly to interject in the interview and ask the parents, couldn't they see how deeply their disappointment hurt their daughter? Wasn't it baldly apparent how very much this girl wanted nothing more than to make her parents proud? That it hurt her, probably more than anything else in her short life, to make her parents unhappy? And if they could see that--for who couldn't, who was observing that situation?--why on earth were they continuing to heap blame upon her? Even if some of her previous actions had indeed influenced her vision (which, they probably did not), what was done was done. No amount of scolding could make her vision 20/20 again. In short--what was the point of their displeasure with their daughter?
But even though I wanted to rip into the parents for their behavior, I knew it wasn't my place as the medical student (nor, might I add, would it have been my place as the attending...at least, not if I wanted to keep a good rapport with this family). So I'm standing there wondering how my attending would handle this somewhat awkward, and, to me, deeply painful, situation. Would she point out that the parents were being unkind? Would she be able to do so without offending them? And most important, would she be able to help them accept their daughter's vision and address it accordingly with a visit to an ophthalmologist?
In wonderful-role-model fashion, my excellent attending did all three, simply by suggesting that perhaps the girl had been sitting so close to the television precisely because she had difficulty seeing, and not the other way round. She also pointed out that the patient was upset because she was watching her Mom and Dad act visibly worked up. How could they expect her to even want to wear glasses, if she does indeed need them, if they exhibited such displeasure at the possibility? Both parents literally got looks of sudden realization on their faces, and at least to some small degree, their attitudes shifted and some of the tension in the room lifted. It was pretty masterful, I must say. I don't doubt that when that little girl has her first car accident, her parents will tell her what she did wrong before they say they're glad she's okay. But maybe my attending's small, insightful comment will do something to make those parents think, just a little bit, before blaming their child for all her failings.
By the time my attending and I walked into the patient room after all her screening was completed, the little girl had been frankly crying and was wiping tears off her face. My attending asked why she was upset, and Mom admitted that she had been scolding her for her bad vision, that hadn't Mommy and Daddy told her not to sit so close to the television? But she had done it even when they told her not to, and now her vision was spoiled, and it was all her own doing.
I was so distressed by this whole thing. It reminded me forcibly of times I've gone through difficult situations and my parents, instead of comforting me when it was obvious I needed comforting, instead pointed out the mistakes I had made that had resulted in whatever pain I was feeling. (Case in point: when I accidentally backed into a parked car one night in my junior year of high school, setting off a cascade of events including police involvement, which was completely out of proportion to the tiny scratches my car had made on the victim's car, which was already heavily dented, I came home sobbing because I felt so terrified about having my first "accident." My mom's response? "I told you not to go out to that party tonight! Why did you drive home so late? Why were you on that street anyway? Who told you to give your friend a ride home? You shouldn't have done all those things," and, the implication was, your tears can only be blamed on yourself.)
This tendency to blame instead of comfort, to point out wrongs instead of pointing out solutions, is a terrible pattern my parents have demonstrated again and again. I suspect it's common to a lot of immigrant families, especially Asian ones. I wanted so badly to interject in the interview and ask the parents, couldn't they see how deeply their disappointment hurt their daughter? Wasn't it baldly apparent how very much this girl wanted nothing more than to make her parents proud? That it hurt her, probably more than anything else in her short life, to make her parents unhappy? And if they could see that--for who couldn't, who was observing that situation?--why on earth were they continuing to heap blame upon her? Even if some of her previous actions had indeed influenced her vision (which, they probably did not), what was done was done. No amount of scolding could make her vision 20/20 again. In short--what was the point of their displeasure with their daughter?
But even though I wanted to rip into the parents for their behavior, I knew it wasn't my place as the medical student (nor, might I add, would it have been my place as the attending...at least, not if I wanted to keep a good rapport with this family). So I'm standing there wondering how my attending would handle this somewhat awkward, and, to me, deeply painful, situation. Would she point out that the parents were being unkind? Would she be able to do so without offending them? And most important, would she be able to help them accept their daughter's vision and address it accordingly with a visit to an ophthalmologist?
In wonderful-role-model fashion, my excellent attending did all three, simply by suggesting that perhaps the girl had been sitting so close to the television precisely because she had difficulty seeing, and not the other way round. She also pointed out that the patient was upset because she was watching her Mom and Dad act visibly worked up. How could they expect her to even want to wear glasses, if she does indeed need them, if they exhibited such displeasure at the possibility? Both parents literally got looks of sudden realization on their faces, and at least to some small degree, their attitudes shifted and some of the tension in the room lifted. It was pretty masterful, I must say. I don't doubt that when that little girl has her first car accident, her parents will tell her what she did wrong before they say they're glad she's okay. But maybe my attending's small, insightful comment will do something to make those parents think, just a little bit, before blaming their child for all her failings.
