Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Family visits: No one ever regrets coming too soon

Amy Cowan, MD
Physician
February 9, 2017
137 Shares
Share
Tweet
Share

Startled out of sleep, I reflexively reach for my beeping pager. For a split second, I lie poised between wakefulness and terror in the pitch-dark resident call room, not sure where I am or what happened. I resolve to sleep with the lights on from now on.

I dial the call-back number.

“Pod A,” a caffeinated voice chirps. It’s Candice, one of the nurses.

“Hi. Amy here, returning a page,” I murmur.

“Oh hi, Dr. Cowan,” she says. “I just wanted to let you know that the family is all here. They’re ready for the meeting.” Her voice is sweet. At sixty-three, Candice is still practicing ICU nursing — at night, no less. She loves it.

“Candice, what are you talking about? What meeting?” I ask.

“They said that when you spoke with them by phone yesterday, you told them to come in. So they did — all of them. They drove up today, and now they’re here, ready for a family meeting,” she says matter-of-factly.

“Candice!” I hiss. “It’s two o’clock in the morning. I’m the night resident. We aren’t having a family meeting at 2:00 a.m.!”

“Well, you did tell them to come in,” she counters.

“Candice, that’s what I tell everyone who asks if they should come to see a loved one,” I say curtly. Truthfully, I’ve never met anyone who regretted coming in.

“The family must have misunderstood me,” I continue, a whine creeping into my voice. “A meeting should happen in the light of day. With the whole team.”

“The family said you’re their doctor. They want a meeting with you,” she replies calmly.

Checkmate.

“I’m on my way,” I mutter reluctantly.

“Great! They’re in the conference room.”

Her cheer only fuels my anxiety. I imagine tomorrow morning’s sign-out: Will the ICU attending physician be upset that this took place without him? Will I be in trouble?

Slipping tired feet into well-worn clogs, I grab my white coat and pull my greasy hair into a ponytail. My blue scrubs are ill-fitting; I’m between sizes again.

Night shifts have wreaked havoc on my life. To cope, I eat constantly. At night, I eat to stay awake. By day, if I can’t sleep, I eat to fall asleep.

Graham crackers and peanut butter packet in hand, I find a vacant computer and review the latest on Mr. Matthews, an elderly, comatose and very sick man. Except for the downward trend in his lab findings–more anemia and worsening renal failure — nothing has changed. It’s as if Mr. Matthews is stalling as he approaches the inevitable.

The conference room seems more like a utility closet with tissue boxes than a room where serious news is delivered. Peering through the door, I see that Mr. Matthews’ family has arranged the fold-up chairs in a circle. Based on the noise level, it’s obvious that most of them haven’t seen each other in quite some time.

Walking in, I’m greeted by immediate silence. I take no offense: I’m familiar with this part of the drill. The group is sizing me up, waiting for bad news. These people have no medical background. They farm. They raise cattle, sheep and alfalfa, things I haven’t got a clue about. They’re reading me — my face, my body language — and waiting. The room is frozen. In order to do my best, I have to connect with them on a personal level, and I have to do it quickly.

Pushing my glasses to the top of my head, I pull up a chair and sit down with them.

“I’m Dr. Amy Cowan, the resident taking care of your father,” I say.

More silence, more staring eyes. Taking a new tactic, I turn to the young mother next to me.

“What a beautiful baby you have!” I exclaim. It’s so off the wall, I’m not even sure I said it.

The room exhales. She smiles.

“Would you like to hold him?” she asks.

“Absolutely!” I say with complete certainty. The first thing all night I know how to handle. I reach for the hand sanitizer, douse my hands and rub the stuff up both arms, just to be safe.

At six weeks, this tiny boy resembles an ancient holy man, wizened by years of sun. Wrapped tightly in his blanket, he blinks and scowls as I reach to cradle him. The family’s tension eases, and the room fills instead with the weight of the conversation to come.

Mr. Matthews has been the patriarch for this family for decades. Now he’s unable to make decisions for himself. To learn what he would have wanted for his end-of-life care, I need to ask his family. They’re the experts about this man. I’m not.

Without an advance directive or named healthy proxy, I have to start from scratch. My scratch is nothing scientific; it’s simple, basic and nothing I was taught in medical school.

“What was he like, you know, before all this?” I ask, looking directly at one of the men in flannel.

“You mean, at home on the ranch?” He wants to be sure he gets it right.

“Yeah. What did he, like, what really mattered to him, what would he never do?”

The stories start out in snippets. His daughter tells about last spring when one of the cows tipped over and pinned her dad to the ground. Afterward, despite being stiff and sore, he was adamant about not seeking medical attention. For days he limped around the ranch, using a stick he’d fashioned into a cane.

His brother-in-law tells of their duck-hunting trips. They often spent whole days behind a blind, storytelling and drinking beer. When the jokes and stories ran out, they enjoyed the silence.

“Grandpa’s medicine bottles haven’t been opened,” the baby’s mother says. “He didn’t care for doctors. No disrespect.”

The stories become lively — even funny, when his practical jokes are remembered. Occasionally, a woman in the room wipes away tears. It’s becoming clear that this was a fiercely independent man with a contagious sense of humor. Despite the gravity of the subject, at times I laugh too.

The weight of this sleeping baby calms me. I realize that I’m bearing witness to the full circle of this family. In my arms lies their next generation, while nearby machines keep their past alive.

Their stories tell me more about this man than any lab value could. The stories guide me to make a medical recommendation that will honor what matters most to him.

Later that morning, Mr. Matthews dies on his own terms, comfortably, with his family surrounding him.

No one ever regrets coming too soon.

Pulse logo 180 x 150Amy Cowan is a hospitalist. This piece was originally published in Pulse — voices from the heart of medicine. 

Image credit: Shutterstock.com

Prev

This doctor is a pro-choice physician. Which means she promotes life.

February 9, 2017 Kevin 84
…
Next

Vik or Vikram: The challenge of physician identity

February 9, 2017 Kevin 0
…

Tagged as: Hospital-Based Medicine, Hospitalist

Post navigation

< Previous Post
This doctor is a pro-choice physician. Which means she promotes life.
Next Post >
Vik or Vikram: The challenge of physician identity

More by Amy Cowan, MD

  • Rage Against the Machine: This song is mine, and it’s how I heal

    Amy Cowan, MD
  • Another chance to practice self-compassion

    Amy Cowan, MD

Related Posts

  • 5 ways to maintain family bonds in medical school

    Micaela Stevenson
  • Is medicine really a model family-friendly profession?

    Kristina Fiore
  • You’re lucky to have a medical student in the family

    Nathaniel Fleming
  • What are your health goals for the coming year? [PODCAST]

    The Podcast by KevinMD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Family medicine and the fight for the soul of health care

    Timothy Hoff, PhD

More in Physician

  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Practicing medicine with conviction

    Arthur Lazarus, MD, MBA
  • The power of memory in shaping human identity

    Emily F. Peters and Sandeep Jauhar, MD, PhD
  • Physicians have no autonomy. Here’s how to change that.

    Diane W. Shannon, MD, MPH
  • The erosion of patient care

    Laura de la Torre, MD
  • Navigating adulthood in the digital age

    Eleanor Menzin, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Lab Tests That Escape FDA Oversight May Come Under Agency Review
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Low Tidal Volume Compliance Still Lacking in Mechanical Ventilation
  • IV Immunoglobulin May Cut Infection Risk of Anti-BCMA Agents for Myeloma
  • When's the Best Time to Get the Updated COVID Shot?

Meeting Coverage

  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Plant-Based Estrogen Improves Lipids in Postmenopausal Women
  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Family visits: No one ever regrets coming too soon
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...