Ms. G. perched on the exam table across from me. Her hair was now graying like mine. It had been a long time since our last visit, spanning the Covid-19 pandemic, more than a year with no hairstyling to mask how much we had aged.
At routine annual exams, I have always asked my patients to tell me how they have been since we last met and what issues they most want us to discuss. Now I also ask how they’ve been during such a difficult and stressful time.
Ms. G. answered that she was peaceful: she knew God was protecting her, although she accepted that she also had to do her part to stay healthy. Then she told me that both her son and her mother had died just before the pandemic and her father had died the previous year.
Ms. G. and I have known each other for many years. I knew that her family lived far away. She talked often about her son, who had been paralyzed in a devastating accident years earlier.
After a year in which I sometimes felt overwhelmed by the accumulating losses that my patients have suffered, I was struck by Ms. G.’s quiet acceptance. She said she was grateful that her son had died before Covid so she could fly out to say goodbye. He wasn’t cremated until she had seen his body, and no one had put makeup on him, so she saw him just as he was; she sat with him and knew he was with God, no longer suffering.
As we talked, the tears started rolling down my cheeks. My flimsy plastic visor fogged up until I pulled it off, then laid my glasses next to it on the desk. We sat together and talked about faith, about suffering, about strength.
But there is an inevitable moment in primary care visits when even heartbreaking stories end, when we remember we need to recheck the blood pressure or do the Pap smear, make a plan to adjust the diabetes medication, or just acknowledge that the appointment is running longer than its allotted slot and there are other patients waiting.
This time I hesitated. I find it harder to disagree than to empathize, and in my nonprofessional life, I avoid conflict whenever possible. But my work requires disagreement and persuasion, in fact centers on motivational interviewing as I try to counter what my patients are hearing in the media or from their families and friends. Each day, I encourage someone who is reluctant to take a medicine to treat their cholesterol or osteoporosis, or I refuse to prescribe hydroxychloroquine for Covid-19 or a narcotic for chronic pain. Each time, I think about how to persuade without losing trust.
I knew that Ms. G. had not yet been vaccinated against Covid. And I have seen so many people sick, have read the literature documenting the vaccine’s incredible efficacy and safety, have rested my belief in the power of science. But Ms. G. poured out the reasons she didn’t believe in the vaccine: it doesn’t work against the variants, if you get the vaccine you won’t wear a mask, and more. Most important, God would keep her safe. She didn’t need this vaccine.
The moment felt fragile, as the emotional tone shifted; our disagreement loomed as I put my glasses back on and logged back into the computer. I thought about Ms. G.’s vulnerability to infection and my responsibility to help her stay healthy. And how her decision would have ripple effects on others, might harm those she most loved and feed the spread of sickness in her community.
I thought about Ms. G.’s strength — how the faith that I felt inclined to battle against was fundamental to her well-being and her ability to thrive despite unimaginable loss. I considered how to honor her ability to make choices about her health without abdicating my role as a source of medical expertise. Reciting the facts, I described the minuscule risk of a serious adverse effect from the vaccine, versus the significant risk of Covid, but Ms. G.’s skeptical expression was easy to recognize even above her mask. And so I told her that I respected her beliefs, and I reflected back her earlier assertion that she would do her part to stay healthy. I told her about my experience getting vaccinated and asserted my belief in the vaccine’s efficacy. I asked her to think about it, because I wanted the best for her, wanted her to stay safe. I tried to plant the seed for change.
Mulling over our conversation, I keep thinking about trust. I circle back to this tension between trusting and disagreeing, to the question of how to maintain a relationship in the face of profoundly different beliefs and choices. I have had similar conversations, over and over, with patients who don’t want to get the Covid vaccine — about their mistrust of medical institutions and providers, of science, of politicians; their feeling of being pressured; and their fear of being harmed. One distraught young woman had been warned by her family that the vaccine would make her infertile. And I think about the racism and misogyny that have so often shaped medical care in our country, and the ways in which such experiences color our relationships and our individual decisions about our health.
No matter how much I want to convince Ms. G. to get vaccinated, I know that in medicine, relationship and trust are fundamental to healing. I uncomfortably juggle these two conflicting imperatives and try not to let my frustration turn into anger. And so I stepped back to let Ms. G. think about what to do next. After our visit, I sent her this essay, with the hope that we might, together, navigate this collision of persuasion, faith, and trust.
Four months later, Ms. G. remains unvaccinated. She graciously thanked me for writing to her and gave me permission to share our story. And she has come back to see me twice. Each time, she is double-masked and open to my other treatment recommendations. And although I continue to wonder what more I could do, I believe that what we can both do is continue to talk. Amid the strident vaccination rhetoric that surrounds us, our dialogue feels like a meaningful and therapeutic exchange.
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