You started off as my doctor

Maheswaran, Charuka

“You started off as my doctor, now you are my friend.”  he said to me.

 “That makes it very difficult for me to be your doctor.” I replied.

I saw the sad acknowledgment in his eyes the moment I said it and I felt a passing regret, but I knew in my heart of hearts it was right and so did he.  He has many friends, but I am his only doctor.  I can care for him without being embroiled in the emotions of losing a friend.  To allow him to be the focus and not my emotions is the honour I am giving him I told myself.

We had started off on this journey together where I was only supposed to be an inconstant companion, until the cancer was found.

I came to Canada for this: to accompany my patients from cradle to grave and everything in between.  Little did I know how it would feel to accompany them at the end and be the one left behind.

Births are such joyous occasions and if you do it right, you are merely there to stop the baby bouncing onto the cold tile floor.  But death has always been the old enemy.  The one we do battle with, with all the arsenals in our possession, but who will always win in the end.

One of our purposes as doctors is to out-maneuver death, if only for one more day to let the living live, to let them play with their children, laugh with their friends, hold hands with their spouse or share dinner with their families and breathe the soft sunset air.  That is our gift to them, to society and to our world, often to the detriment of our own families.  Someone else has to tie my son’s shoelaces, brush my daughter’s hair, laugh at my husband’s jokes and chat with my friends and family for the time that I am taking care of you.  I do this gladly, whether expected or not, whether appreciated or not.  Although appreciated is always nice.

I believe we can do all this as doctors without blurring the lines too much.  A person has many friends but only one family doctor.  One person you trust with your partner’s infidelity, your financial worries, the fear your son is taking drugs and the mole on your arm that has changed it’s appearance.

Every time a person I have just met tells me something they have never told anyone else before, my first thought is how brave they are.  To walk into a room and tell a stranger what is worrying you most in the world in the hopes they can fix it.  What a privilege and burden it can be -- whether it is spousal abuse, sexual abuse or cancer.  In our jobs we deal with the mundane, insane and profane, interspersed with the profound.  And that is daily – what interesting lives we lead, what stories we could tell.

As junior doctors it was one of our tasks to pronounce death when on-call.  Without fail, regardless of our religious leanings we all wrote “Rest in Peace” at the end of our notes; the final words in the hospital notes, the final words in the medical chapter of that life.  Here, in rural medicine I can be there as much towards the end as the patient wants.  It is a privilege to their hold a hand as they are dying and to comfort them that death does not have to be agony, it can be rest and peace.  Most people are afraid of death, of ceasing to be, of leaving the known.  We as doctors deal with death and sometimes even make deals with him or god or anyone who might be listening: “If you let this child live, I promise to….”.  But we know that sometimes it can be a serene end – the rest we deserve after a full and well-lived life.

We had all these plans in place, my patient and I.  After long discussions he decided he wanted to die at home, with his wife’s blessing and agreement.  He decided he would like minimal intervention and no resuscitation.  He had decided I would be his doctor until the end.

So it was with some surprise that I found him in hospital after the weekend, admitted under the on-call doctor. His wife had brought him in after he had collapsed at home.  She had, as I suspected she would, changed her mind about looking after him alone at home.  It is a burden that some cannot bear and understandably so.  Every carer needs differing levels of support and she was unable to cope with the decision she had made.  Ultimately, she did not want to look after him alone at the end and she knew it was fast approaching.

My colleague in the practice insisted on keeping him under his care.  His rationale was that he had looked after him for two years and he belonged to him.  My rationale was that I had found the cancer despite him looking after him for two years and I had been co-ordinating his palliative care.  I decided to acquiesce.   This man was not a turf war.

I went to my ex-patient to say hello and explain that another doctor would be looking after him from now on.  He was weak and tired.  I told him I would still visit him every day.   He said he was glad and would look forward to my smile.  I sat with him and chatted for a while with him and his wife.

 I could now be his friend and not his doctor.  As it turned out, he got his wish in the end.

Theme: Community | Communauté
Theme: Death and Dying | Décès et le mourir
Theme: Patients | Patients
Theme: Physicians | Médecins
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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