When I knew

Varley, Talia

I always worried that medicine would be far too exciting for my blood – emergent clinical cases requiring split-second decision making, operating rooms involving death-defying surgeries, and code blue calls necessitating intensive resuscitations. Quickly, though, I learned that such clinical scenarios amount to less than a single percent of clinical work leaving greater than ninety-nine percent of one’s clinical time focused on matters of much lesser acuity.

As I entered the world of residency in Family Medicine, I began to worry that my new career would be far too boring… quite converse from my original concern. Day after day, sore throat after ear infection, patient after patient demanding prescription refills only at the very end of a lengthy appointment; it all began to seem rather unexciting.

Sometimes it felt less like I was a physician and more like an automated prescription writer, giving people access to the medications and massage therapy referrals that they most wanted. I gradually began to realize, however, that there were opportunities for distinct novel clinical encounters to better blend bread and butter as well as more remarkable cases; a new promising professional mélange began to seem possible.

I still remember my first palliative care home visit. I entered the house so carefully behind my preceptor, unsure as to whether or not to remove my shoes. As my preceptor greeted family members awaiting our arrival, I looked up at the woman who opened the door and saw my uncertainty and nervousness over what was indeed a trivial matter.

“Oh, please do leave on your shoes. Come in, come in!” she said in such a delightfully friendly manner. From her haphazardly applied lipstick leaving pink remnants on her front teeth to her mismatched crocks exposing her colourful purple socks beneath, she was most notably adorned by a gracious smile.

“He is down here,” she told us, “come with me.”

We followed her down the main staircase leading to the basement where a sickly gentleman lay in a hospital bed, juxtaposed against a bookcase of old photos taken in times of good health and the general scenery of a happy home. Astride bedpans and pureed edibles introduced out of necessity in the palliative setting, his lasting dignity was assuredly held in the decorum of such surrounding home comforts.

“He just seems to have refused any food over the last few days,” said a voice from the crowd of family who had followed us downstairs. “I just don’t know what to do,” his daughter said tenderly. She had taken on the responsibility of caring for him since his diagnosis of liver cancer only months earlier. Taking a leave from work to care for her ailing parent, she had been so beautifully invested in restoring a sense of calm and acceptance to the innate nature of her father’s death. Now, as the end drew near, that air of ease once so carefully established seemed to be ebbing away.

As our visit passed, we reviewed the patient’s current state, his intake and output, as well as his analgesia and general comfort. With our time coming to a close, we had not yet told the family anything of which they were not already appraised; no medications had been altered, no new interventions had been discussed, and no new hope was offered. Only kind words and gentle expressions of sympathy seemed to have held any import.

I followed my preceptor as he began escalating the stairs and looked back to see a room full of family members eagerly tending to their patriarch. Arriving at the front door, I reached for the doorknob and quietly swung it open as a voice emerged from behind me.

“Thank you, I can’t tell you how much we appreciate your coming,” our original greeter at the door whispered upon our exit.

“Funny,” I thought to myself, “it didn’t really feel like we did anything at all.”

How wrong I was. Reflecting on my experience over the following days, I came to realize the power of presence and support that we as physicians can have. Whether or not medical management is necessary, the clinical comfort of having a physician whom you have known and trusted over generations within a family is of ineffable value and meaning to patients; and I now recognize this to further be an inexorable privilege for us as physicians as well.

From themes of death and dying, my clinical training progressed to my Obstetrics and Gynecology rotation with a rather contrary focus on birth and new life. With a spectrum from vigilant new mothers pampering their newborns to careful expectant women waiting for the big day, I shared in many special moments with patients who only came to know me for an ephemeral period. The case that resonates with me most, however, is an unusual delivery room encounter which brings a grin to my face even to this day.

“Alright, it’s time to push,” I said after a long period of sitting by the bedside, waiting for a strong contraction as we move closer towards delivery.

A struggling voice unexpectedly emerged from the background noise of loud pages overhead and beeping IV resuscitation lines. “Hello?”

I looked up and saw the mother-to-be holding a cell phone in her hand and watching attentively as the television displayed the daily news.

“I’m afraid it’s time to push now,” I repeated once more with a somewhat quizzical tenor to my speech.

She looked at me, and then held her cell phone closely only to exclaim, “I can’t talk now, I’m pushing!” She subsequently ended the phone call and tossed the phone by her side watching it as it bounced on the spring-like mattress by her hips, finally landing close to her heart.

“Now push, push hard!” I exclaimed. The phone began to ring only as soon as I finished once again asking her to push.

“Hello?” I heard once more. The mother-to-be seemed to happily be ready for another chat (which I could only hope would be more brief than the previous one).

Likely with a facial expression of mere incredulity, I turned toward the patient’s nurse but expressed no words. She answered my facial expression with a bursting smile and shook her head leisurely with a soft chuckle.

“Not in my 25 years as a nurse have I ever seen such a thing!” the nurse exclaimed, still overwhelmed by such a novel sight.

“I guess you never really see it all… that must be what makes medicine so interesting even decades down the line,” I noted.

That is when I knew that I was a family physician – and in it for the long haul. From helping a woman to deliver her baby into the world, no matter how comically, to visiting palliative patients in the comfort of their own homes, we have the privilege of being invited into patients’ most intimate moments. And sometimes, these experiences just might provide us with some great stories to tell along the way; whether they bring life lessons to our loved ones, or laughter when shared with colleagues.

Theme: Birth | Naissance
Theme: Death and Dying | Décès et le mourir
Theme: Family | Famille 
Theme: Patients | Patients
Theme: Relationships | Relations
Theme: Teaching and Learning | Enseignement et apprentissage

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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