The Community in Family and Community Medicine

Feldman, Kymm

Dr. Smart holds the print out of the abnormal result in her hand. This will take some time to sort through. She glances at the list for her morning clinic. Double booked in the first two time slots. She gets that familiar pang of anxiety. She is behind, before even starting. 

Being an excellent family physician and knowing her patients well, Dr. Smart can often accurately predict why each person is coming to see her on any particular day. She walks into the waiting room. Four patients are already waiting. Each smiles a friendly hello, the subtext of which reads I better be first.

There’s Bea, a 90 year old woman who is relatively well but is slowly requiring more help at home. Nathalie is here with her baby Matthew, she’s a lovely new mom having some difficulty coping. Ava is an extremely capable young single mother who has recently been laid off. And Steven, a man in his late 30’s, continues to get back together with a woman who repeatedly breaks up with him. He’s likely having trouble sleeping again. 

“Hi all”, says Dr. Smart, the familiar apology looming at her lips.

“I am really sorry, but something urgent has come up which requires my immediate attention. There will be a bit of a wait this morning. Bea,” she says, “If you feel comfortable, would you share some of your wonderful stories with the others? I know that everyone here would gain a lot from them.”
Dr. Smart winks at her secretary. Bea’s eyes light up, a performer at heart, she gets ready to launch into some of her best. Steven almost imperceptibly rolls his eyes. Nathalie and baby become ever so slightly more anxious and Ava smiles and settles into her chair, happy to lose her troubles in a good tale. Dr. Smart retreats into the privacy of the overcrowded-under-dusted-chart-pile that is her office.

“Well,” Bea begins, “It was 1943 and you may not believe this, but I was a beautiful young woman. Not the prettiest of my nine sisters, but by far the smartest. I had a lot of suitors but I found that they bored me. So I found myself 23 and single, a spinster by the standard of the day. I slowly saw my dreams of true love and family slipping away. Then one evening I was at the dance hall with my youngest and most beautiful sister. This very tall but somewhat disagreeable looking man approached the two of us. I waited for him to ask my sister to dance, she expected the same and was preparing to respectfully decline. But he fixed his gaze upon me and wouldn’t let go. I felt the strangest sensation right then, I knew that this was the stare of a man who somehow knew me, all of me. The night was magical. We danced long after the band stopped playing. Those moments were the closest any moments of my life have been to perfection, before or since. He walked me home that night, my parents thought me long asleep. We took the smallest steps that we could because we wanted our time together to last forever. When we were one block from my house, out of nowhere a car came speeding around the corner, out of control. We both spun around, he pushed me out of the way with all the force of a man in love. And then he was gone. His lifeless body lay by the side of the road.”

Bea shakes the image out of her head; her mind returns to the waiting room. Nathalie has tears streaming down her exhausted face, Matthew, fast asleep in her arms. Steven’s jaw is open, his bottom lip slack, and his eyes are brimming with tears. Ava’s brow is furled with a look of concern as she leans forward as if longing to take Bea’s hand.
“This is not a sad story,” Bea corrects. “This is a story of true love. I remain faithful to that love to this day. I am so blessed to know it and the memory is so crisp that it might have happened yesterday. You see, I got exactly what I needed. I got to know true love, a feeling that was lost on most of my sisters, and I also got the life of independence that I longed for as an intelligent woman in those days. I worked for many years as a nanny, taking care of others’ children. So I had plenty of children around and also had a room of my own. I have had more love in my life than most, and I have really lived, no regrets. The tragedy is actually that this fierce independence that defines me is now fading. I find that simple things have become chores rather than routines. I am actually here to talk to Dr. Smart about getting some help at home. Maybe I need to consider one of those homes, you know, for the old people,” she says this with a half-smile that betrays her true thoughts.

Ava speaks first as she moves to the seat beside Bea, she grasps her old and well worn hand.
“I am here today to talk to Dr. Smart about my financial situation. I am a single mom with two beautiful children and I just lost my job. If you could, I would love it if you would consider hiring me to help you for as long as you need.”

“Well that would be perfect my dear,” Bea says feeling giddy.

Nathalie whispers, “I know what you mean about losing your independence.” She feels so guilty for saying it but she goes on, “I love my Matthew but I think I’ve been resenting him for taking my independence away. I feel so afraid, so weighed down by this huge responsibility and I can’t even breastfeed properly, he’s losing weight. I’m a terrible mother.”

Ava and Bea take turns reassuring Nathalie that her feelings are completely normal, that most new moms feel this way. They then wake up Matthew to review his latch until it’s perfect. 

Steven is deep in thought. Independence is something that he hasn’t valued himself. Not ever. Hearing how others regard independence, he realizes for the first time that he has perhaps been afraid of it rather than drawn to it. Furthermore, the way that Bea described her love, he has never felt that way. Not about his ex, not about anyone. He decides that he deserves to feel this way and for someone to feel this way about him. He would no longer stay up nights, praying, hoping, mourning the end of his relationship. He would start to recognize the importance of his independence. He would develop it. Cherish it. 

Dr. Smart walks back into the waiting room to find Steven on his way out and Ava, Nathalie and Bea exchanging phone numbers. 

“Thanks Dr. Smart, I’m good. See you later,” Steven says.
“Thanks so much Dr. Smart,” Bea practically sings as all three women head out the door of the clinic.

Dr. Smart smiles and sends her secretary a knowing glance, “now that’s what I call family and community medicine.”

Theme: Community | Communauté
Theme: Patients | Patients
Theme: Relationships | Relations
Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.  




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