Medicine from the heart . . . Tina Runyan

On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit:


Christine (Tina) Runyan, PhD, clinical associate professor of family medicine & community health and director of the behavioral health fellowship, sees her patients at Hahnemann Family Health Center. Her reflective piece truly captures how some of our work can deeply impact us emotionally. She also offers us a glimpse of one of those moments when we have to weigh the many magnetic forces in our life that "demand" our presence and choose just one at a time. Her story will help all of us to feel more at peace with those decisions.—Hugh Silk, MD


Three Questions

I made it to my car before I broke down in tears. I had just come from the hospital having seen a young woman with a serious perinatal illness who nearly died in childbirth a few weeks earlier. I felt as tightly pulled in so many directions as the skin atop a snare drum. I was supposed to be home an hour ago and my daughter had already called twice. I had a grant report due by five o’clock, and too many emails in my inbox asking about something due or overdue. I felt as if I was letting everyone down and I couldn’t wait for the day to come to a close so I could just lie in bed and read stories to my children.

And then it came to me—the three questions. One of the favorite stories in my home is a children’s adaptation of Leo Tolstoy’s short story about a little boy who poses three questions to the wise turtle because he often finds himself unsure if he is doing the right thing.

The three questions are:

  1. When is the best time to do things?
  2. Who is the most important one?
  3. What is the right thing to do?

All I knew about the woman I went to see in the hospital was a little bit of history about her disease, the medical events to date, and that she was refusing to see her baby, which was concerning all involved in her care and upsetting her family. There was worry about severe postpartum depression or psychosis. I entered the room to find a listless and soft-spoken woman with sunken eyes, too weak to reach for her water glass. Her husband and soul mate of nearly two decades, steadfast by her bedside for weeks, left us alone to talk.

She didn’t start with “the story.” Instead, she told me all about the life she and her husband had built together. She told me about her family. She described her longstanding uncertainty and the numerous conversations she and her husband had about whether to even have children. She told me about her birthing classes and her labor plan and her hopes for the baby’s first hours after delivery. She cried.

She detailed the weeks leading up to the illness and C-section and her emotions toward her obstetrical doctors. She explained how defeated she felt and how she does not have the stamina to even sit upright in a chair for any length of time. I tried not to cry. She kept telling me how dismissed she felt and how no one was listening to her—everyone was saying how good she looked and she still felt as rotten today as a few weeks ago when she nearly died.

An hour and a half later as I stood to leave, she looked me tearfully in the eye and asked, “Will you come see me tomorrow?” Even though I was feeling time slip through my hands like dry sand, I looked right back and said, “Of course I will.”

So as I sat in my car it was exquisitely clear that the best time to do things was now, in this only moment we know to be certain; the most important one is the one you are with; and the right thing to do is to do good for the person you are with. I took a deep breath and took comfort in knowing I was exactly where I needed to be this afternoon. My drive home was serene. And the bedtime story that night goes without saying.