“Pia, my dear, it’s a blessing to see you. We have all missed you. All the sisters ask about you day after day.”

“And you, Reverend Mother.”

Pia kept her eyes glued to her hands as they worked at each other in her lap. Her anxiety had peaked. She hoped it was not reflected in her voice. She had dressed simply in a black dress that broke at the knees and plain pumps. At first glance, the mother superior had looked the same as when she first met her ten years before. The uniform of the order helped with that. But Pia could tell that age was taking its toll. The mother superior had moved slowly when she walked around her desk to greet Pia. From Pia’s perspective her hand had felt bonier and more delicate when she placed it on Pia’s shoulder than on Pia’s previous visit a month or so previously.

On the short train ride out of Manhattan, Pia had rehearsed what she was going to say. She wanted to be clear so there would be no misunderstanding. She was confident in her decision, more confident then than she’d been in Rothman’s office, but she knew the mother superior had a talent for ignoring what someone was saying as she worked the conversation back to a position more in tune with her interests and opinions.

As the pleasantries continued, Pia’s mind rapidly played over the extraordinary changes her life had taken since she arrived at the convent in what, at that moment, seemed like a previous life. She was now in her fourth year at Columbia Medical School, as amazing as that sounded even to her. She recalled how difficult it had been to convince Columbia to accept her. She remembered how she’d had to explain why, at age eighteen, she’d decided to join a Catholic African missionary order. Her experience at New York University had been a breeze. From the get-go the college admissions people were convinced, no questions asked, that Pia, as a young woman emancipated from foster care, would make a valuable addition to the rich tapestry of NYU undergraduate life.

Columbia, on the other hand, had expressed early concern about Pia’s history and its potential effects on her independence and ability to empathize with patients. They didn’t voice their concerns in such a clear fashion, but Pia had gotten the message, especially when she was asked to undergo an interview by one of the medical center’s psychiatrists. Recognizing that she wouldn’t have been asked to do the interview if they weren’t interested in her, Pia had acquiesced. To her surprise, the interview turned out to be more pleasant than she had feared. The psychiatrist had been well versed in the inequities of the New York foster care system and seemed sympathetic when he learned that she had been under its questionable aegis from age six to eighteen. Unfortunately, she had never experienced an adoption or even a final placement.

Although the psychiatrist did not have access to her records by law, Pia was rather open with him and explained her experiences, although she downplayed some of the grittier elements. She fully admitted that in retrospect she knew that she had been abused and that she had had to grow up without a nurturing presence in her life, but she added that rather than hindering her, she believed, her experiences would make her a better doctor. She also downplayed any symptoms she’d experienced such as her mild brush with an eating disorder as a teenager and the recurrent nightmares she still experienced.