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.
Kristin Mallett, MD, PGY2 and soon to be chief resident at Hahnemann Family Health Center, writes about visiting a patient trying to hang onto her independence. Dr. Mallett skillfully walks the balancing act of offering hope for prolonging independence while being careful to pursue safety for her patient. That delicate dance that we are forced to do so often as family practitioners is truly an art, and a success story in this case, indeed. –Hugh Silk, MD
I raise my hand to knock on Samantha’s door but stop mid-knock, realizing it’s probably open. Do I knock and force her to come to the door? Or do I just let myself in, not wanting to be rude but knowing there’s a step she has to clear before being able to come to the door. I don’t knock, and let myself in. I’m a quiet person, but I try to be as loud as possible so she knows I’m here.
“Dr. Mallett!!! Look!!!” Samantha answers when I make myself known. She is waiting for me at her kitchen table, pushes back her wheelchair and stands. She takes two steps forward then two steps back into the chair. “I couldn’t do that last time!” Samantha is 79 and recovering from a hip replacement. The surgery was put off for months after many setbacks including a DVT and a broken wrist. She finally was well enough to have the surgery and is now back home after another brief stay in rehab. I met her months ago on a similar home visit. This was before surgery and she depended on her daughter a lot. While her daughter clearly cares about her, they don’t always see eye to eye on a lot of things, mainly what Samantha can and cannot do. Since the most recent surgery, her daughter has given up trying to win these arguments. This time when I called her before coming, she was defeated and just told me to talk to Samantha. She did hint that she was worried about a staircase.
Samantha brags to me that none of her friends has doctors making home visits. She feels privileged and loves that I can visit with her. She makes it clear that she needs me now, but expects to be fully functional in a couple of months, and plans on driving again to make it to the clinic for appointments. I’m not so sure about this, but cannot crush her spirit.
She points toward her staircase and says, “I can make it all the way up with the physical therapist helping me. In a couple of days I’m going to try it on my own!”
I ask if it would be okay for me to go up the stairs to see what she will have to navigate on her own. She agrees. As I’m going up, she yells, “There’s 14 of them!” knowing that I’m counting the steps. The stairwell is carpeted in vintage 1960s brown shag. There is a railing on the left, but none on the right. Despite a cane waiting for her at both the top and bottom, I’m picturing her plummeting to her death my entire way up.
When I reach the top of the stairwell, I realize what is so important to her. Her own bedroom, neat and tidy with her bed made, waits for her just a few feet from the landing, not slept in for months. Oddly, the most striking thing about her bedroom is the (again vintage 1960s) Panelfold wooden closet door that folds up like an accordion when open but is now spanning the length of one entire wall. I notice this because my own bedroom at home has the same Panelfold door. When I think of my bedroom, I think “Panelfold.” It is something we have in common, although very uncommon nowadays.
I return to Samantha’s kitchen table where we chat. We take care of the requisite medical questions and she turns the focus on getting better. I don’t have the heart to tell her I agree with her daughter. It is safer and easier for her to continue sleeping in the twin bed in her kitchen. I understand why she wants to go upstairs and think if I were her, I would want the same thing. I manage to get her to commit to not trying the stairs on her own until the physical therapist tells her it’s OK. I distract her from her next goal which is driving; I need to discuss this with her daughter first, specifically if she can arrange a driving test before letting her loose on the roads again.
This is only my second time meeting Samantha and my one word description of her is “determined.” She wants things to go back to the way they were before, and as an outsider looking in it seems to me like there’s no way that’s going to happen. I think Samantha might realize this over time, which is why I don’t want to force these issues on her, especially the second time meeting her. There is time for me to see her again certainly before she starts driving, but I still worry about her falling down the stairs. Independence is frequently clung to by the elderly, and Samantha is hanging on for dear life. I appreciate being able to help her maintain it, but I have the feeling that she will not be independent for much longer. Maybe I don’t even have to tell her this, because on some level I’m sure she knows. For now I will keep visiting her and will do my best to keep her independent.