This is what’s so difficult about doctoring

There was nothing wrong with Sarah’s vocal cords. Her tumor had spread throughout the abdomen, but her voice was unaffected. Yet minutes after learning of the voraciousness of her metastases, she pursed her lips and began to communicate with head nods and hand gestures only.

I met her for the first time in the nursing home. I sat down quietly at her bedside on a Sunday morning. I was in the midst of a weekend call rotation that would last fourteen days. Then, because of a scheduling snafu, I would have a few evenings off before starting my next two week stint. Only one weekend to rest all month.

We communicated in the most rudimentary fashion. I asking open ended questions, and she nodding from time to time. Her body was growing week. Her belly had become progressively distended, and she was no longer eating. I called her closest relative, a sister half way across the country. We talked of hospice and palliative care.

When I spoke of dying, Sarah would close her eyes. Complex conversations were reduced to the most basic. It took almost a week to establish her wish to be DNR, and a few more days to get consent for hospice. All the while juggling multiple crises at once, my sleep schedule was interrupted on a nightly basis. There were other patients drowning in a sea of disease and frailty. And I, muscles overwhelmed with lactic acid, was trying to row a lifeboat to each lonely oasis.

When Sarah began to die in earnest, I called her sister and asked her to come. After hours of travel, she arrived at the bedside late Friday evening. Relaxing on the couch in preparation for my sparingly precious days of rest, the mobile rang at my side. It was my answering service.

Dr. Grumet, I know you’re off this weekend, but the nursing home called and said that it was an absolute emergency.

Indeed it was. Sarah was dying. Her sister was petrified and wanted me to come to the bedside. My partner on call new nothing about the case, and the hospice team hadn’t arrived yet.

And this is what’s so difficult about doctoring. Our patients and their families so desperately need us to be engaged and present. Yet being there is often inconvenient, exhausting, and ultimately unhealthy. We delay sleep, impose on our spouses, and deny our children.

We met briefly the next morning. My wife and kids ate breakfast at the Panera next door as I sat with the two sisters whose hands laid intertwined on the bed. Although Sarah was fading quickly, she had just enough strength to lift her head. I barely recognized the soft syllables that tumbled tentatively from her lips.

Thank you!

They were the first and last words I ever heard her say. I nodded my head graciously, and ambled next door to join my family for breakfast.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.

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  • Ron Smith

    Great post, Jordan.

    About fifteen years ago, I remember going through a phase where I was dejected with medicine. I began to question my career. It seemed that most of my kids ails consisted of mostly snotty noses, coughs, colic, and diaper rash.

    This was before the age of smart phones. I learned to hate my beeper. I was the only Pediatrician in Wise County, population about 25,000 or so. I was on call…well, I was on call!

    I was seeing 40 patients a day. I had moved my young family there to slow down from the first 6 1/2 years when I was doing level 3 neonatal care and working 16 to 18 hours a day. I had become an employed practitioner with Cook Fort Worth’s Children’s Hospital. About a two years in they were going to cut my pay. I was already making less than the newly-certified residents were getting their first in practice. I seriously considered leaving medicine then.

    But I hung in there. I moved my family to Fayetteville, Georgia. Things got better despite struggling with a severely handicapped child of my own.

    What I realized just in time was that of all the things that I needed to guard, including being a business owner, keeping my board certification, staying up with current medical information, and so on, my attitude was most important.

    Now thirty years out, I can look back and see how important that discovery was. Attitude is something that my patients and parents pick up on the quickest. Children are more than snotty noses or ‘interesting cases.’ I’m more interested in how they are going to turn out. One of those little hands will someday perhaps return the favor of a tender nurses or physician’s touch at my hospital bedside or on an OR table.

    Life is truly an amazing gift but it is the little ‘inconveniences’ like yours that suddenly make what physicians (and NPs and PAs) worth it. Keep up the great work. I wish you all the best!

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • SarahJ89

      And having been with a new mother who’s absolutely terrified by her infant’s clogged up nose and impaired breathing, I can tell you the phone call you had with her in which you were patient and supportive made a HUGE difference.

      • Ron Smith

        And your point is well taken, Sarah. As I get older in medicine, my new parents sort of stay the same age. I may have answered a specific question thousands of times before, but for that parent it is new and concerning, whatever else I internally my think at first blush.

        That is why I guard my attitude so that each time that I go through discussions about fever or croup or cough or runny nose, that I consistently give the best of myself.

        My father was a natural gas pipeliner. That’s a sophisticated way of saying that he was a ditch digger. I loved him and worked with him in every aspect of the business. In Texas summers, where the job site might be two or more miles along side the highway, he stopped me more than once as a was running from various points along the ditch where different things were happening and told me to walk.

        I’ll never forgot that he told me more than once, “Son, don’t run. Remember you have to last all day.”

        In medicine, I take the long view. My good attitude is essential if I’m going to last another 10 years or more beyond the thirty under my belt. I want to do as good a job as I can and when I answer that last phone call, I can feel like its been a job well done.

        Warmest regards,

        Ron Smith, MD
        www (adot) ronsmithmd (adot) com

        • SarahJ89

          OMG, I never thought of that! You’re right. You’re marching in place as your patients’ parents get younger. Or so it seems.