Medicine from the heart . . . Christopher Chang

January 10, 2013

Written by Christopher Chang, MD, a resident at Barre Family Health Center, this memo is fitting for the holiday season, not just for its title but because of the spirit it embodies. His act of going the extra mile is exactly what medicine needs at this time. His action on behalf of a patient he recently met, to bring closure to her admission, discharge and life trajectory is a meaningful one. This sort of sincere caring is not one that is easily taught to medical learners.—Hugh Silk, MD

Home for the Holidays

The holidays usually mean time spent at home with family. In residency, it often means time spent working, trying to shirk off work, or feeling sorry for the people who are working so that you don’t need to. It’s also a miserable time for patients who are stuck in the hospital or creating regrettable holiday memories. Family members who are visiting for the holidays anyway end up spending their entire vacation in the hospital. Home takes on a new meaning when you’re critically ill. It’s usually not the place you expected to be, but ends up being the place where you are.

We had discharged her to hospice over two weeks ago. At the time, she was suffering from worsening shortness of breath due to a large and growing mass in her lung. When she came into the hospital, she had wanted everything done—as would most people. We could have done more expensive tests, more scans, more biopsies, to confirm that her prognosis was poor. Instead, she and her family had finally opted to simply keep her comfortable. On the morning that she left the hospital, we had sat with her while she ate her oatmeal. I tried to reassure her that things would be fine, that she would like the hospice facility. “What do you mean? My children are going to take me home.” Whoops. Right. I remembered from the conversation with the case manager the day before: The patient wanted to go home, but the family did not think they would be able to handle her care there, and so had opted, apparently without the patient’s knowledge, to send her to a facility. “They’ll be in later to discuss it with you,” I backpedaled.

I pulled into the driveway of the hospice home, having missed the turn once. I wasn’t sure if she was still living there, or even if she was still alive. I had meant to come last week but was tied up at work. When I told a co-worker I was planning on a home visit after my shift, she had unknowingly joked, “What’s the rush?” It had been a busy shift, and the week of nights was finally getting to me. I had decided it could wait, and finally here I was.

The building was low-set, discreet. It could have been any other house in the neighborhood set on the water. I walked in the front door and through the glass foyer. The floor was covered with clean blue carpet. Poinsettias and pine boughs decorated the main sitting area for winter. Placards directed the way through the hall and down the stairs to patients’ rooms. I looked for a nursing station or a receptionist and was dismayed by the lack. It felt like I was intruding on someone’s vacation home, not a health care facility.

I turned the corner, bumping into a nurse. She wore a plain sweater with her blue scrub bottoms and seemed unsurprised to find me. I asked her about my patient. She thought for a second. “Oh . . . She passed away last week.” At my crestfallen look, she continued, “It was very peaceful. All of her family was here with her. You can’t call any death good, but for her, it was . . . peaceful.” We chatted a little more and I thanked her for her time. She added, “God sets your birth date and the day He calls you home. You can only hope to be ready, and she was ready.”

On my way out the door, I felt tears forming. Maybe no loss can be good, but there are deaths that are good, and certainly deaths that are bad. I wished I had been able to see her before she died, but I knew it was as much for my own sake as it was for hers. It had turned out as good as one could hope. She had beer in the fridge, food brought in, loved ones at her bedside through the end, which had been mercifully quick and painless. Even though she wasn’t able to see one last time the place she had called home, she was able to make a new home for herself and be happy there.

Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.