Broken - almost

 After 30 some odd years in medicine, few things have broken me down to tears.  There are times when I get teary - those are usual events especially in what I call a terminal appointment.  The patients know this will be their last visit, and have come to say goodbye and thank you.  

I get to know my patients, and in family medicine I know their families. I know who they are related to - we share stories, and life events all the time.  A new dog or cat - the phones come out and pictures are shown around.  New children, grand children, the same.  The patients rejoice in our team’s lives as well.  We get asked how the soccer game went last night of one of the staff’s children, how did the other nurse’s sheep place in the state fair, etc.  

After so many years, the practice has become a community - and in a way family.  In our clinic there are no barriers - we don’t care what race, religion, or belief system they have.  We are the safe place to bring life’s problems.  No judgements. Just compassionate listening, advice and sometimes a little ass kicking.  

I love it so much, it is why I have not retired.  I want to continue as long as I can - doing the work the universe intends me to.  

But Friday morning - my first patient - almost broke me.  A patient fairly new to us, who in February told us his son, who had been fighting a serious autoimmune disease over the past few years, had died. He was asking for help to get through all the planning for the funeral, memorial services etc.  And without a thought I sent an appropriate medication to him as fast as I could.  He came in on Friday to follow up - a bereavement visit.  They are common in our office.  But this one.  This one hurt.  His 15 year old son developed an autoimmune colitis which came out of no where 2 years prior.  This father did everything, took his son to the best doctors, advocated for him, because the nature of the illness was so uncommon in someone so young.  

They had finally achieved some stability with his health when once again the child last fall started having issues again.  Upon hospitalization it was found his liver was blocked - and after several procedures, it was reconciled.  A short time later,  the child’s liver started to fail - and after extensive testing he was placed on a liver transplant list.  Days after he had finalized the testing, was back home, he started with fevers and wound up back in the hospital - and this time the scans found a mass which biopsy showed to be malignant.  

The father recounted this in a matter of fact manner - but I saw his pain - but just let him speak.  He spoke of the teams of doctors who came in to discuss his son’s care - giving options of chemo or palliative care.  The father was frustrated in that he felt the doctors would not come straight out with a prognosis.  Finally he was told that even with chemo, they were looking at months left of life.  The boy’s mother by that time was unable to participate - her grief was so deep.  My patient made the decision to place his son in palliative care - mostly comfort care because they apparently don’t put children in hospice!?  His wife was unable to stay because they had another child at home and my patient could see she was not going to handle her son’s passing well.  So when she left for the evening - he made the decision to remove supportive care for his son was unresponsive at that time. And upon removal, he crawled into his son’s bed and held him until he passed.  I was trying so hard to hold it together for him, because that’s my job, but my insides were a mess. 

He went on to tell me he agreed to an autopsy because the cancer his son had was aggressive and uncommon - almost unheard of in children.  He wanted me to tell him he did the right thing, which I did for it was the right thing to further the understanding of what happened for future cases.  He thanked me so many times for being there for him and his family as they went through this tragedy - my heart was breaking for him.  I told him I felt he was so brave to make the decision to let his son go.  

We talked about grief, and how over time you get distance from it but you never get over losing a loved one. And when it is a child, it is the worst.  He was upset that his coworkers didn’t reach out to support him. He felt let down by them.  He has close family ties but not in our area.  His plan is to eventually relocated back to where his family is.  

As he stood to leave - I asked him if I could hug him - I think I needed the hug more than he but he said, with tears in his eyes - I need one so badly.   I just hugged and hugged him - and he left. 

Then I broke down - an hour late in my schedule, patients backed up - no time to cry.  I walked out of the room crying - and the nurses who knew what was going on were crying as well.  I pulled myself together and went into the next patient, thinking I could hold it together - and apologized for being so behind. She looked at me and said “it must have been a rough visit, it’s all over your face, take your time, take a breath’.  

I was finally able to stuff the tears back and finish my day.  My last patient - a dementia patient ended my day explaining that he wore only his upper dentures because if they broke he could use the lower plate as his upper dentures.  That statement tickled me so much I had to control my laughter. But after he left, back at my work area, I laughed, and then I broke down in tears again.  The emotional roller coaster had caught up to me. 

I did go home and have an ugly cry last night and decided I needed to journal this so I could put this to rest.  These people need me to be a rock right now. And if this is where i need to reconcile my emotions so be it.  I am glad I decided to remove any political opinion from the work I do - as our world systems are breaking, so are the people.  I have to keep my spiritual core bright and compassionate - it is why I went into medicine to begin with.