The Gold Necklace


Rachel Parry, the author of this guest blog is a PharmD student, shown here on a houseboat on the Ashtamudi Lake

The last patient we saw today broke my heart, especially as I learned more about her. She was in her thirties and had suffered from a stroke 4 years ago that left her debilitated and unable to talk. I first saw her lying on her bed, many of her muscles contracted in ways that distorted her joints and made her bones look broken. We made eye contact. I smiled, but couldn’t recognize any change in emotion on her face. I noticed she wore a gold necklace (typically given to brides in Kerala) but the man and woman taking care of her appeared to be her own parents. I thought that was odd, but didn’t dwell on it. She had scars from a tracheotomy after a surgery, and she had been nourished through an ileostomy until she could consume the liquid diet she now lived on. I thought to myself, “I don’t know if this is a life I would choose to live.” Then I looked up and caught her father gazing at her with more love in his eyes than I can describe.


As we were leaving, I found out that my initial assumption that she’d had an ischemic stroke was wrong- it was hemorrhagic. They said she had been trying to divorce her husband who was domestically violent. They didn’t confirm that a traumatic head injury he caused led to the stroke, but they alluded to it. The bleed in her brain could possibly have been from high blood pressure.  Her mom brought out an old photo album with family photos from when she was a child and teenager. The mom showed us photos of her daughter, the patient, with her estranged husband and their own daughter getting her gold bracelets at 28 days old.


I realized the young woman lying in the bed upstairs, unable to move herself, was a mom.


I could see the heartbreak in the patient’s mother’s eyes while she spoke to us in Malayalam. I doubt a husband who abused his wife to the point of causing a stroke allowed her parents to see their granddaughter.


The patient was young. I know her parents loved her, but from where I’m sitting it looks like her entire future was stolen from her- the future where she got to raise her daughter; the future where she got to walk. It was stolen, presumably, by the man who gave her the gold necklace that still hung around her neck.

Editor’s note: Rachel is among 12 students who are participating in India Winterim at the University of Iowa, and more specifically in the Pain and Palliative care course.  This section of the course shadows the hard-working staff at Pallium India, which provides palliative care in Kerala.



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