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Book Chapters – What Our Patients Have Taught Us
June 10, 2024
Below are three chapters from the recent IHS Press book, What Our Patients Have Taught Us: Physicians Reflect on Lessons Learned about Life, Themselves, and Their Profession. To purchase the book, visit our online shopping site.
Indiana Grandma
Timothy Musick, MD
In our family medicine residency, we were “forced” to do home visits. I use the word forced because at that time I believed that everyone was able to leave the house, at least for an hour to come to the doctor’s office. My home visit was with a pleasant lady named Sheri, who lived with her daughter in a nice house in a classic Indiana suburban community. Unknown to the community was that once you got inside her house, the secrets started.
Sherri lived with her daughter who was a hoarder. Sherri had two daughters, the one with a problem with hoarding and another daughter who was a nurse. There was significant tension between the two daughters and poor Sherri was stuck in the middle. Unfortunately for Sherri, she was mostly bed bound secondary to her terrible osteoarthritis and congestive heart failure, and if she was to leave the house, she had to use a wheelchair. This complicated caring for her because if Emergency Medical Services needed to be called, they were unable to get the stretcher into the house due to the hoarding. Her family was thrilled that I was willing to do home visits as none of her specialists would come to her home, making managing Sherri’s multiple medical conditions difficult. She was also on chronic narcotics and according to Indiana law, I was required to see her every three months. As you might expect, Sherri and I became close during these visits.
The home visits started out as a convenient way to leave work early. I would swing by Sherri’s house to say hello, check on her, prescribe her medications, and then move on with my day. Her two daughters were always present, and the tension was palpable. They would argue over the best course of treatment for their mother, and inevitably the discussion would come down to the daughter who was the nurse wanting Sherri to move in with her and move out of her current home with her hoarder daughter.
After a year of multiple visits, I had established a good relationship with both daughters in addition to Sherri. It was during this time that she became interested in my life. She was a sweet lady, her room filled with pictures of family and friends. Her daughter told me she would always light up on the day of my visit and would ensure that her daughter helped her get ready for my visit. I told her about my life, growing up in Nevada and moving to Indiana, where I knew no one. That I had no family in Indiana greatly distressed her, and she insisted that I consider her my “Indiana Grandma.”
She listened to stories about my family, about medical school, how residency was going and so on. She was genuinely interested, wanting to know everything that I was willing to share. We laughed and joked around, and slowly the time that I would spend at her home began to increase as our friendship deepened. Eventually, I would spend the entire two hours at her home—one hour caring for her medical problems and managing medications, and then second hour talking and catching up as only family can do.
Slowly her health began to fade. It started gradually with increased lower extremity swelling and worsening lower leg pain; this led to increased falls. She began falling multiple times a month and eventually was unable to get out of bed without falling. During this time, I saw her more frequently, not out of obligation, but because I wanted to make sure that my Indiana grandma was taken care of and had everything she needed. Her nurse daughter would greet me at the door with a hug, and we would check on Sherri together.
Finally, Sherri was completely bed bound, and she was nearing the end of her life. During a visit, both daughters knew that this was probably the last time that I would see her, and so they excused themselves from the room so that I could talk with her one last time and say good-bye.
I got on my knees, close to her head, and held her hand. She began telling me about her life; she talked about her best friend who died eight years ago, who she missed dearly. Sherri’s eyes sparkled with life and laughter as she told me about the adventures they went on and the good times they shared. It was just like countless times before when she told me stories of her past.
Finally, she began to tire. As I told her I would leave to let her rest, she grabbed my hand and pulled me toward her. She asked me to lean closer, and then she kissed me on the cheek as a grandmother would kiss a child. She told me how proud she was of me, what a great doctor I would be, and how honored she was to have come to know me.
Tears welled up in both our eyes as I thanked her for giving me a home in Indiana and for being my Indiana Grandma. She asked if she could ask me one final favor. She asked me to discuss with her daughters her final wish. Sherri told me that for her final days, all she wanted was “peace in the family.” She wanted nothing more than to have her two daughters stop fighting and be a family. I think she feared that when she was gone that her family would drift apart, and this saddened her. She wanted her daughters to have each other and have the relationship that only sisters can have. I hugged her tightly and told her I would do my best.
Her daughters and I did have that discussion, and they insisted that they would not fight in their mother’s presence. Sherri passed away two weeks later, “old and filled with years, surrounded by family” as written in her daughter’s note to me. In that note, they thanked me for everything and told me that as she passed, she held both daughter’s hands. Sherri finally had the peace that she always wanted.
Sherri taught me that we are more than a physician for one patient. We take care of an entire family. She also taught me that deeply connecting with our patients in a personal way is therapeutic for them as well as for ourselves. In the age of physician burnout, connecting with our patients on a personal level is one of the best ways to get a sense of personal accomplishment and achievement. We give, but we also receive.
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Death Can Be Good
William Cooke, MD
I saw her, a dark silhouette against the setting sun, light shining through the window behind her. Why was she alone? My patient, Mr. Steele, was her husband, and I knew the love she had shared with him had endured the sum of a common man’s life. How would I be able to tell her she would lose him tonight? He had already faded into that shadowland between life and death, just beyond the prevailing light of her love.
Their visits to my office were always a highlight of my busy day. I would sit and listen and ask questions between the routine practice of going over their medical issues and reviewing their treatment plans. He sometimes told me stories of when he served in World War II. One day he lost his usual jovial persona, grew deadly serious, and looked down. I felt the presence of some unseen weight his soul carried. He looked up and through his eyes I could see some terrible blend of fear and regret.
His bottom lip quivered slightly as he spoke: “Soldiers don’t tend to freeze up the first time they shoot someone. I didn’t. No, your training just kicks in, and the damned thing’s done before you even had time to consider it.” He paused and I waited in awed silence: “It’s that next time you have to shoot someone that gets you. Not sure how many good men got shot because they hesitated. You see, every time you take aim after that first time, you remember what happened to that other human being when you pulled the trigger.” His finger pulled the trigger of the invisible gun he pointed in my direction. A chill ran through me as he struck my heart as sure as if he had really shot me.
I thought of that moment as I approached Mr. Steele’s wife. Confronting death is the hardest part of my job. Although not comparable to the physical violence seen in war, the act of telling someone their loved one is dead still feels violent. Mr. Steele was right—you do not think about it the first time. You just follow your training and you do it. There is no memory of that mother’s mournful wails, that son repeatedly punching the wall until his knuckles bled, or that wife whose countenance seemed to shift to sheer terror as she looked around the room confused and asked, “What am I supposed to do now?”
This was all buzzing around my mind as she looked up. I suddenly found myself gazing into the eyes Mr. Steele had lost himself in as a young man and had never recovered. In that moment I could see that she already knew. Past the sadness in her eyes I could see a quiet confidence and what seemed like joy. She must have seen my bewilderment, as a subtle smile gently touched her wrinkled lips.
Her hand, knotted with years, reached out for mine. I wondered if the twists in her fingers matched his as if molded over time into a perfect fit. As our hands touched, I lowered my eyes looking for comfort between the cracks in the floor. I stood there as a professional man in my late thirties feeling like a child. I labored under the burden of my duty as I heard her weathered voice, “Child.”
I instinctively looked up pitifully. My mouth opened and then closed without saying any words.
“Yes, child?” was her reply in such a warm and loving voice, I felt as if she was comforting me.
“I’m sorry,” I stupidly uttered dropping my eyes again. But she understood. She took my other hand and I looked back up. Tears filled both of our eyes and for some inexplicable reason I embraced her. As we turned to walk to her husband’s room together, she told me, “We had a good life together.” She smiled, and continued, “A good life yields a good death, and sometimes death can be good.”
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Where the Poppies Grow
Richard D. Feldman, MD
Frank Shaw was a combat veteran of World War I. He was an elderly man who became my patient in the very early years of my practice. He was born into an Indiana farm family just before the turn of the twentieth century. Frank was probably a couple of years out of high school in 1917 and working on the family farm when the United States entered the war. He was tough, full of patriotism, and the spirit of adventure. He enlisted in the army because he wanted to do his part to serve his country and to help save the world from what he saw as Germany’s evil aggression. Frank was engaged to his high school sweetheart, later becoming his wife of more than sixty-five years. But that marriage would have to wait until he returned “from the war to end all wars.”
Frank was obviously a hearty man in his youth; I could see it in this elderly man even still. He was a big man with that “all-American jaw.” Frank was muscular and tall and still standing straight. He said in his youth that he was very strong and athletic and figured that he had “a better than even chance” in any fight with a German.
I probably never would have known that he was a World War I veteran if I had not asked him. He was not the type to talk about it much unless he was asked; he did not wear his military service on his sleeve. As we came to know one another better, he progressively opened up about his war experiences because of my continual questioning. I was fascinated. It was the historian in me who just wanted to know.
Although he told me of horrific events, he did not seem terribly traumatized from the war in any lasting way, at least that he showed. He had a very calm demeanor. He was a pragmatic, humble person who just did his part for his country so long ago. He told me that while he was on the front lines in France, he was no hero. He was proud to serve, but said more than once, “The heroes were those that didn’t return home.”
Frank was a typical “doughboy” of World War I. He described himself as just an enlisted man with a rife in his hand, a pack on his back, and carrying a few hand grenades. He entered the army and was given some training in the states and then additionally when he arrived in France. He voyaged to Europe on a large ship full of troops and worried all the way they might be hit by a torpedo from one of those German “U-boats.” But the trip was uneventful other than the crowded conditions, poor food, and some seasickness. He was awfully glad to get off that ship and arrive at a camp in England, but the conditions there were also far from adequate. Finally, landing in France, they were warmly welcomed by the French people. He was ready to fight.
Frank recalled the devastation of the French towns and countryside along the way to the frontline trenches. It was not long until he found himself in the thick of things. This certainly was not what he imagined when he enlisted. His naive thoughts and images of gallantry, duty, and triumph began to fade. His eagerness to fight without the real fear of being killed or wounded soon gave way to the reality of the war’s brutality, death, and destruction. It was not going to be as easy as was anticipated to defeat the Germans.
He soon experienced the filth, mud, insects, and rats in the trenches and the stench of the dead. The conditions were terrible and unimaginable. In some areas, the dead from both sides remained everywhere. There were times that there was hardly enough to eat, and his socks and boots were wet for days. Disease was all around him. It was common for troops to die of disease rather than wounds suffered in battle, maybe more common, he said. Pneumonia, dysentery, tuberculosis, influenza, and other infections were always near. Frank recounted that he would look to the sky and see the American combat biplanes overhead. He envied those dashing airmen who flew above the mud and filth and returned in the evenings to their bases to hot meals, comfortable barracks, and clean beds.
I do not remember the battle fronts and the campaigns he engaged in, I only remember that he fought in France, probably mostly in the spring, summer, and fall of 1918. Americans fought in coordination with the French and English. He might have been at the Toul, Chateau-Thierry, or the Meuse-Argonne offensives. But I do recall his description of the fire and thunder of the Allied bombs that proceeded their advances to the German frontline trenches to soften the enemy and their obstacles and barbwire defenses. I remember his descriptions of the anxious waits before being ordered to go “over the top” out of the trenches and running toward the German trenches in “no-man’s land.” It was here that the most terrifying aspects of the battles took place: Running through a hail of bullets whizzing around them and the earth-shattering shelling that fell on them with deafening and disorientating impact. Intermittently, they would jump into bomb craters for protection and then get up and run again. He saw friends blown apart by those bombs and others slowing dying of their bullet and shrapnel wounds. A few became debilitated and trembled with emotional “shell shock.” They always worried about being gassed.
Finding his way to the German trenches, he engaged in some hand-to-hand combat with bayonets, knives, and firearms. “I killed some Germans,” he said reluctantly as he looked down at the floor. But he recounted that he was fortunately only involved in intense hand-to-hand fighting a few times. Overtaking a German trench was many times more of a round-up of prisoners with sporadic fighting, as the enemy was overwhelmed with the effects of the preceding trench bombing and the resulting disorganization. He recalled, “We were certainly attacked by the Germans too, but we were never overrun. Overall, I was fortunate, it could have been much worse.”
Frank reflected that somehow, he amazingly got out alive and without a major injury. He suffered a relatively minor shrapnel wound in the leg that earned him a Purple Heart. He showed me the scar: “I was so lucky, unlike the many of my friends who fought along with me. I guess surviving was a crapshoot. I will always remember those young boys who were robbed of living their full lives.” He recalled that there were times in battle that the justifications and reasons for fighting the war left him. He was merely fighting out of anger for those Americans who were brutally killed to avenge their deaths, I suppose. It was in those times that fear totally left him on the battlefield.
Frank was proud of his service and put it in terms of, “We did what we had to do.” He believed in the cause to save the world from tyranny. But that experience, I believe, also gave him the ability to view the world with the eyes of a much more mature man who more fully appreciated freedom, family and community, and the value of life. And always, he realized that war is a tragedy, a waste of human life, and something horrific that no one should have to experience. He seemed torn between the necessity and the senselessness of war.
He did not normally display or disclose is service to his country to others. But every year around Armistice Day, he did something I thought was a little out of character. He would give his friends and acquaintances he happened to encounter a little red paper poppy with a small, attached card. I received one of those poppies. The card contained that famous poem by Lieutenant Colonel John McCrae, MD of the Canadian Army, titled “In Flanders Fields”:
In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.
We are the Dead, Short days ago
We lived, felt dawn, saw the sunset glow,
Loved and were loved, and now we lie
In Flanders fields
Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.
Remarkably, I think the poem precisely reflects the tension that Frank felt in his soul: Believing in one’s duty and the rightfulness of fighting the enemy in that great conflict yet lamenting the necessity and irrationality of war with its tragic enormous losses. I believe giving out the paper poppies was his tribute to his unforgotten fallen friends. I can only begin to imagine what his wartime experiences were like. But he gave me a glimpse.
Frank gave me a unique understanding of patriotism, sacrifice, courage, bravery, and commitment to something greater than oneself. All these things revealed in a person of great humility, selflessness, sensitivity, and humanism. A good combination, I think.
One day I asked him if he knew the song, “Mademoiselle from Armentieres,” so much associated with the English and American troops in World War I. How I was familiar with it escapes me. He responded assuredly, “Of course!” To my surprise, he proceeded to sing the first verse in a whispered voice, so no one would hear him outside the exam room:
Mademoiselle from Armentieres
Parlez-vous
Mademoiselle from Armentiers
Parlez-vous
Mademoiselle from Armentieres
She hasn’t been kissed for 40 years
Hinky-dinky parlez-vous
At his next visit, he invited me to sing it with him. We sang together in whispered voices, and we smiled.
Frank eventually left Indianapolis to be closer to his two sons in his advanced age. We hugged at the conclusion of his final office visit, and he thanked me for the medical care he had received from me. I never heard from him again. I am proud to have known him. He always wanted to return to France to visit the battlefields and the American cemeteries. I hope he had the chance to do so.
Frank gave me many gifts from the heart along with one of those paper poppies. I have it to this day.
