“Your next patient is here just for a shot—her third HPV vaccine,” the medical assistant says, handing me a plastic blue tray bearing the syringe, Band-Aid, and alcohol wipe.

I take the tray and the chart and step into the exam room to find an adolescent girl sitting quietly on the table. She smiles at my greeting—until her eyes fall on the hypodermic needle.

“Here for your final HPV shot?” I say in a subdued voice. “Did you have any reaction to the last one?”

The girl shakes her head. “No, it hurt for a little while—but I got over it fine.”

I drop the medical chart on the countertop and approach her with the tray in hand. She's an attractive girl with long brown hair and green eyes. Although her face looks vaguely familiar, I can't recall the last time I might have seen it. Our practice has grown so much that sometimes I have to introduce myself to an established patient because we've never met.

“Which arm today—do you have a preference?” I ask.

“The lady who brought me back said you'd use my right arm today,” she says, struggling to pull up her tight sleeve.

I help push the sleeve higher, exposing the deltoid, then clean the skin with the alcohol wipe. “Just a tiny pinch,” I say, deftly inserting the needle into the belly of the muscle. “There—all done. We'll give you a Snoopy Band-Aid for your trouble.”

“Thanks.” She pulls her sleeve down and fiddles with the button at the cuff. “Do I need to come back?”

“Let's see,” I say, opening her chart. “You're due for your annual physical exam in six months. You can schedule an appointment on your way out today if you'd like.”

She walks down the hallway. As I scribble a short note in the chart, my eyes glimpse the words recorded on the problem sheet under the heading of family history: “Mother: cancer of the kidney—chemotherapy completed;” then, in different ink, the telltale concluding phrase: “deceased—2006.”

I flip through the chart, scanning years of data in moments of time, until I find the latest entry in my own handwriting: a physical exam when this girl was 10 years old. From that time forward, her mother had scheduled annual examinations with one of several female pediatricians in our practice. I hadn't seen this girl in six years. Three years had elapsed since her mother's death, yet no one had ever informed me about the mother's diagnosis or subsequent demise.

Years ago, I read Edna O'Brien's Wild Decembers—a tightly crafted tale about Michael Bugler, an Irish emigrant who returns from Australia to claim the family farm as his inheritance. At some point a woman named Rosemary appears, someone who knew and loved Bugler years before. The tale reaches its climax when Bugler's neighbor Joe Brennan murders him in a fit of rage after Brennan learns of his sister's love for the man.

Later, when she hears of Bugler's death, Rosemary lapses into a reverie of impassioned grief. Her one desire is to turn back the hands of a massive clock in a hopeless attempt to bring Bugler back to life.

“Half an hour ago I did not know it, half an hour ago he was in the fields, his hat, my hat, pushed forward to keep the light out of his eyes,” she muses to herself, even though Bugler has been dead for days.

Turning back the clock is something most of us have wished to do at one time or another. We experience the loss of a loved one, or the parent of a patient under our care takes a turn for the worse. If only we could turn back the clock, we think, everything would be just fine.

In his masterwork A Grief Observed (New York, NY: Bantam Books; 1961), C.S. Lewis explores his feelings of despair in the aftermath of his wife's untimely death from cancer. At one point, he writes: “I have no photograph of her that's any good. I cannot even see her face distinctly in my imagination.”

Once again the girl's face appears before me. I close my eyes, trying to remember, trying to recall that other face, the one I hadn't seen in years, the face of her deceased mother. Somehow, like Lewis, I can't seem to bring it to mind.

Grief is the one creditor that must be paid: The bill always comes. Only in this case, it arrived 3 years late, I think, as I quietly close the chart. JAAPA

Brian T. Maurer, PA-C, practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and a member of the JAAPA editorial board. Visit the author at http://briantmaurer.wordpress.com.