On life, and death

I’ve been working on trying to schedule one home visit a week lately. It seems that there is usually at least one patient who for a myriad of reasons cannot make the physical trip into clinic. It is not as easy as it sounds to schedule a home visit. Although the patient and family often have flexible schedules, finding a solid hour in my day can be very hard for my staff – especially when the request comes last minute, as it often does.

The last few home visits have been with hospice patients. The last two have been patients in similar situations, and I’ve been truly honored to be a part of their care. The first of the pair I first met on a Friday. Why is it always on a Friday? As she shuffled slowly into the exam room, I saw her jaundiced skin and broad smile and knew. How much weight have you lost? Well, I started this diet a few months ago trying to lose about 10 pounds but then I just couldn’t eat anything – I’ve lost 50 pounds. Do you have any pain in your belly? No, I feel just fine other than I can’t eat. Have you noticed anything different about your skin or your eyes? No, why? After gently palpating the mass in her epigastrium, I sent a flag to my staff asking them to reschedule the last patient of the day. As we talked more and got to know each other I learned she had 3 children – all of them had been born at home with the help of her family. She had never been to a doctor before. She had been married for nearly 70 years and they had never slept apart. She liked to can apricots. As we talked, I was cautiously gauging her and her husband. How would they react? Did they, like many, already know? What could I say?

They did not know. They were stunned, he was sobbing. Yes, I was sure. A CT would show it. No, it was not likely anything could be done.
They did want the CT scan, so off they went only to return an hour later just as I was hanging up with the radiologist. It was worse than I expected.

We talked over coffee for the next hour, and then I called hospice. We’d like a last romantic weekend alone together at home – please have them come on Monday. No, I don’t think we’ll need a home visit next week, but our kids are coming and they will have questions – can we come for an office visit next Friday?

It is 2:00 the next Friday and I get flag from my staff. She can’t come, she’s been having trouble today. Appointments are shuffled, other patients are very accommodating. My medical assistant and I are able to go out to the home at the end of the day. She is dying, surrounded by her family. They are scared and look to me for direction, reassurance, confirmation, and hope.

This. This is why I’m here. This is why we struggle through MCAT’s, Gross Anatomy, biochemistry, third year of medical school, internship, residency. This is why we stay awake at the bedside for hours on end, while someone else tucks our kids in and gives them a kiss from Mommy. This is the pot at the end of a long rainbow, and I am so truly honored to be a part of it. Happy Match Day.