Patey, Paul

The slot on the wall outside the room has two charts, which I briefly examine. I know this beautiful couple well. David is 91, Susan 89; they have been married 64 years. Their mutually exchanged love for each other is surrounded by an array of mutually shared loves for family, friends, home, activities and interests. Their life has been rich with meaning. They both know their shared life is nearing its end yet enjoy the sunset with peace and without fear.

I enter the room. The greeting is brief. They also know me well. To a family doctor the first instantaneous glimpse and sound of a familiar patient is very revealing. In that moment a comparison of today is made with the patient's condition on the most recent previous encounter and with the anticipated state of the patient's health. In this case they seem unchanged but I sense a slight increased alertness.

"Who's first?" I say.
Rather quickly Susan responds: "David, tend to him first."
To Susan I say, "How has David been lately?"
"Oh, about the same."
"Anything new?"
"No, not really." I shift my glance to David, and repeat "Anything new?"
"No, not really" David replies without significant concern. I wait. He continues.
"My knees is awful stiff in the mornings. I get winded going upgrade or against the wind. But I hardly ever uses the spray. No pain. I'm up three or four times at night with me water trouble, but that's about the same."
"How many pillows at night?" I ask, as I pat the pillow on the examining table. Patients often confuse the words 'pillow' and 'pill'.
"Two, same as always."
"Do you get short-breathed at night?"
"No doctor."
To which Susan adds: "He sleeps good, except for getting up to make his water, and I keeps a little hall light on."

This suggests his mild congestive heart failure is no worse.

Our focus on David's health continues; proceeding from history to examination, during which I listen to that magnificent heart that has pumped for more than 91 years. Now it is in trouble. The muscle is weakening and a valve is giving out. His heart murmur has certainly gotten louder in the past year and the heart bigger.

"You're about the same David, but that heart valve is a bit more leaky."
"I guess it's I like me knees doctor - worn out. But it will do me for the rest of my journey."
David is wise and serene.

Susan has sat through this visit. She has seen and appreciated the careful attention I paid to her beloved man, to his few words, and his body, relatively sturdy in advanced old age despite progressing degenerative diseases. She knows his pills help but do not cure his troubles.

"Now, Susan. How have you been?"
With a tone of concern she replies "Oh, pretty good, but there's something here I wants you to look at." She moves her right hand to her shirt, overlying the left breast.
"I'll wait outside now," says David, as he moves from sitting to standing.

Susan gently nods. David departs. He has thereby shown why they wanted me to attend to him first.

The story of the newly-discovered lump is brief. Susan has major concern. Her other health problems are stable. Examination reveals a firm lump in the left breast, irregular in shape; about three cm in diameter but not attached to skin nor underlying chest wall. From how it feels I strongly suspect it is breast cancer.

"Susan, what you found is a lump in your breast. It needs to be removed. Depending on what it is you may need further surgery."
"What do you think it is, Doctor?"
I give the question back to her: "What were you wondering, Susan?"
"I thought it might be a cancer?" she says, with a questioning tone to the last word.
"Yes, it might be. But there's no signs of spread beyond the breast. What do you want me to tell David?"
To no surprise to me Susan's reply is one word. "Everything."
"Then you get dressed. I'll get David back in and we will talk."
I leave. Susan dresses, David returns.

I return to Susan and David, sitting side by side: together they share a comforting nearness.

To David I say: "She told you?"
"Yes, doctor." he gently replies.
"Susan, as I said, the lump needs to come out soon. Very likely it will turn out to be a cancer. We'll see what the lab says. If it is, the doctor will probably want to remove the breast."
They both nod.
"I will talk to the surgeon on the phone. Meanwhile, there's some tests I will arrange about the rest of your health. That will be helpful information for the surgeon."
I reassure them of my continuing involvement. "Do you have any more questions?" "Not now doctor." They depart.

Immediately after they leave, I go to the door of the clinical encounter room, lean against the door post and watch them together walking down the corridor. Susan is erect and her walk gracious. She probably had that same walking pattern more than 64 years ago when, in their small rural community church she walked down the aisle with David on their wedding day. On the other hand, David, once a striding logger, now totters slightly on his worn out knees. Susan matches her speed to his. For more than 65 years they have been a comforting nearness to each other. They will be for the remainder of their shared journey, encumbered though it may be by the burdens of life, including David's worn mitral valve and Susan's new cancer.

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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