Friday, March 30, 2012

Much Ado About Nothing

It was that time of the month again and Mrs. S hobbled feebly into my office. She was 95 years old and we had been through alot together: three hospitalizations, a heart attack, congestive heart failure, atrial fibrilation, spinal stenosis, and pneumonia. Yet, she looked remarkably good for her 95 years. She lived alone in a three story house and somehow managed. Her husband died over 30 years ago and she had no children or other living family. She was alone.

While Mrs. S fought a brave fight, she now was being challenged by a disease that I knew I couldn’t fix. She was going blind. As her vision worsened, her ability to take care of herself faltered. We had long talks about this. It troubled me, as a physician, because I knew there was no recourse. She had gone to 6 different ophthalmologists in the last 6 months and all said the same thing.

I reviewed my notes on Mrs. S. My assessment and plan looked something like this:
1)cad/chf: stable on current lasix dose, chest pain free
2)atrial fibrillation: INR stable, re check in one month
3)spinal stenosis: stable
4)visual loss: follow up with ophthalmology

I was tortured by how little I could do for her. As I said goodbye, I suggested that she didn't need to return for 3 months, her medical issues were stable. She gave a weak smile.

How about next month?


As a new medical student I experienced my first care giver relationship. I volunteered for hospice and was given the name of an elderly gentleman dying of prostate cancer. His condo was close to mine, and I would walk over once a week to spend time with him. I did little things like cleaned around the house or occasionally wound run to the grocery store. Often, we would pass the hours just talking.

I call this my first care giver experience although many would argue that I wasn’t really delivering any medical care. I, in fact believe, that it is the exact opposite. As a first year medical student, I didn’t know much about medicine. It was before my mind was clouded by diagnosis and symptoms, drugs and pathophysiology. My lack of medical knowledge allowed me to get to the core of what this gentleman needed: An attentive listener, someone to say they were sorry for his condition, someone to be there.

As I moved along in my medical education I forgot the art of “just being there”. As a resident and young attending, I was always too busy making diagnosis, prescribing medications, and planning the next step. But every now and then I would get caught in a situation where I no longer had anything left to do. Where all the appropriate actions had been taken and yet the patient still wasn’t getting better. These situations used to bother me. As I get older they do so much less.

As with my hospice patient I knew there was very little I could do for Mrs. S. She would eventually lose her sight completely. But I started to go back to my premedical way of thinking and take a more optimistic look. I could continue to be there for Mrs. S. I could hold her hand and say I'm sorry that she is going through this. I could keep my door open and let her know that no matter what happens, I would support her. I would be in her corner if she needed a hand.
I know, sounds like alot of nothing. But sometimes “doing nothing” is some of the best medical care I give!

1 comment:

Maggie said...

So often 'doing nothing' is best. Around our place we sometimes tell each other, "Don't just DO something; STAND there ... and wait to see what if anything needs doing."

For this patient, though, there might be something to do. (or maybe I'm being impertinent -- if so, I'm sorry in advance). I understand the VA's health center in West Haven, CT, offers a number of work-arounds and supports for people who are losing their sight ... and you don't have to be a Vet to use their services!

Maybe you already knew about this, and maybe you've made the referral. But since Jane Brody's article (Dec 2010, I think) mentioned that the patient's eye specialist had no idea. ... maybe crowdsourcing could help.

I so appreciate what you write, and the care you take of your patients.