I’ve been out of med school for twenty-five years now. Somehow, I thought by now I would be the beloved owner of my own practice, my name on the lips of every family in town … or a full professor sitting comfortably in my book-lined office … and in between I would rush in and out of the hospital, my white coat starched and clean, to provide impressive and timely medical care without messing up my hair.
Instead, this happens: It’s a Tuesday night. I’m on service. I have eight patients, and I saw seven of them this morning (no white coat and no starch, just gray wrapover black pants and clogs). The eighth was off the floor for a test, and I tried again at lunch, but then she was in endoscopy, so I left to pick up my daughter from school. When we got home, she was upset about failing her math test, so I had to sit with her on the couch for a little while and go through the test with her to figure out what went wrong. Then I looked up and the sun was falling in the sky. It was almost five, and I still hadn’t seen my last patient. I asked my kid if she was okay staying home by herself for forty minutes while I ran over to the hospital, but she wasn’t. So I bundled her into the car and took her with me.
Now it’s 5:20. The hospital lobby is streaming with visitors. I have fallen even below the black pants and gray unstructured wrap standard and am now wearing black pants and a gray fleece sweatshirt that is warm, but not new. It doesn’t make me look like a doctor. Also, my hair is kind of straggly. Also, my ten-year-old is bopping along next to me, hoping I will lose my head and take her shopping in the gift shop. I promised her a dinner out at the trendy pizza place when we were done here. I park her on a chair in the lobby near a bunch of sedate-looking women in their seventies (when I come back, she will tell me that they left almost immediately, to be replaced by a “guy in a hoodie who got thrown out by the security guards,” for what I don’t know. I will respond, mildly, that I have a hoodie too.) I walk as fast as I can back to the endoscopy unit, hoping that my patient isn’t so zonked after her EGD that she doesn’t remember me coming to see her.
The unit is dark, except for one patient: my lady, frail and over ninety, but alert and sharp as a tack after two of Versed and twenty-five of Fentanyl. The nurses in this unit don’t know me, and think I am her daughter coming to visit. I point, wordlessly, at my badge. (In case you are wondering, over the last twenty-five years, I have reminded people that I am, in fact, the doctor, on average five times per day.) “You survived,” I say, succinctly, to my patient, who takes my hand in her own frail, skeletal one. “I guess I did,” she says, as though surprised herself. She has been losing weight, and while I think it’s depression, we needed to make sure her EGD was normal. She asks where my daughter is. Was I coming to see her so late in the day? My daughter wants to make sure I have something planned for her dinner. When I name the restaurant we are planning to visit, she relaxes. Ever the caretaker worries about my ten-year-old getting enough to eat, while in the midst of her own medical workup near the end of her life.
I don’t have a mother, or a grandmother, who calls me and worries about these things. My patients are my family, for better or worse. I have arrived at this midlife place without many supports – my dad is nearby; I have a best friend who is battling cancer and busy with her own family; I have neighbors who take in my trash cans while I’m at work. That’s it. My daughter’s friends’ parents are nice and helpful when I ask for it, but there is no one who calls me up on Saturday mornings, asks me if I need a bagel delivery, or offers to babysit. Not even anyone who worries that my sweet pea won’t eat enough on a school night. My patients, bless them, do this.
I squeeze my patient’s hand. I tell her that so far, everything looks normal and we think she needs to go home to be with her family and eat chicken soup. And McDonald’s. And ice cream when she is in the mood. She weighs barely one hundred pounds, about ten pounds more than the gourmet pizza eater who even now awaits me in the lounge. “I am coming to see you at home next week, and I want to see empty takeout containers all over the house,” I tell her in my most threatening way. She squeezes back and laughs. “Take good care of your girl,” she tells me. “I always do,” I say back.
It’s strange how the years pass. When I was younger, I had a simpler view of my life: I would attain certain milestones because I deserved them, not too early and not too late; I would proceed majestically through my career, through dating and marriage and having children, and arrive at retirement with a full complement of adoring fans. I didn’t anticipate job changes, lateral moves, and eating crackers alone in front of my laptop at dinnertime. I didn’t anticipate that my patients would become my family. I didn’t anticipate that the caring and the work would flow both ways.
My patient looks me in the eye. “I’m good,” she says. “Go take your daughter for pizza.” She gives my hand one last squeeze, and then she lets me go.
Joanne Wilkinson is a family physician and contributor, Becoming Doctors 25 Years Later: Twenty five physicians sharing the journey from medical student to retirement.
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