Last February I began announcing to my patients that I would be retiring in August. A few weeks later, March 2020, the regional health network of which my rural family practice is a small cog decided to curtail face-to-face visits to protect all of us, patients and providers, from exposure to SARS-CoV-2. Today I’m saying goodbye to my patients of 39 years via telehealth.
For several years now, especially after my older partner retired but no doubt because they also noticed my own grey temples, my patients have been asking me, “Are you next?” Or demanded, “Don’t you retire, too!” Or more than one: “You can’t quit practicing until I die!” So I’ve had plenty of time to ponder how I would say my goodbyes. Give fair warning: “But I’ll still be here to see you back for your next 3-month follow up.” Add a bit of boilerplate in the After Visit Summary including my younger colleagues’ names and the assurance, “You’ll be in good hands.” The obligatory form letter to my entire panel, its wording vetted by the compliance office.
The actual farewells, though, have been more intense than I anticipated. I predicted pretty well which grey-haired women (my age!) would ask for a final hug but I never expected the man whose chronic pain I had barely held at bay through the years to tear up and clasp me like a brother. Now it’s May and many more adieu’s yet to come. Currently I’m saying goodbye on the phone or via video link. Patients are asking, “Will I ever see you again in person?”
Will they? Well, it’s a small town. We might raise a hand passing at Food Lion, separated by six feet, although masked we might not recognize each other. What they really mean is will we ever again share together that sacred space, the exam room. Sacred, from Latin sacrare, to set apart: when the door closes the chamber becomes a place for telling and hearing secrets. It is the domain of eye contact and subtle body language. For the healer who can resist the impulse to leap into every hesitation it may become a realm of powerful silences. I am proud of my skills at juggling meds, managing a dozen co-morbidities, recognizing the occasional obscure syndrome, but my highest aspiration has been to master that quarter hour in the presence of one fellow human creature.
My patients are missing a final personal encounter. I am missing hundreds; just one more pale hue in the infinite spectrum of pain this coronavirus is causing. By the time I walk away will we have re-opened our doors? Will our state ever have adequate community-wide testing and surveillance or universal contact tracing? I am in the demographic that is one errant sneeze away from the ICU and a ventilator. Would I be willing to sit down tomorrow twenty-four inches from my next patient and peer at them from behind an ear-loop mask? One sneeze. I am afraid.
I don’t really care that the pandemic has robbed me of going out with the bang of vigorous full daily schedules and stuck me with a whimper. I’m already over the fact that my last few paychecks will be perceptibly slimmer. My deeper sense of loss is like arriving at the dock to wave at the ship that has already cast off its moorings. Can I call it back to harbor? Four decades as a small town family doc teaches a very peculiar sort of generosity – the ability to conceal from your patients your level of personal woe. But this is not the annoyance of another interrupted family meal nor the aggravation of a few hours of lost sleep. This month or the next we will begin to lift some physical distancing restrictions. Will I be generous enough to expand my schedule, to risk my patient’s virus so that we can experience face to face the completion of our long journey together? For whom would I be willing to make that sacrifice? For my patients? Or for me?
. . . . . . .
Care
She opens the jeweled box of care
and unfolds first one
then another – fragile,
painful, frayed.
She falters then lets me touch them:
melancholy scent of longing,
golden afternoon interrupted forever
by thunder,
stained silk of loss;
this shared hour sighs away
past recapture
but the air about her flickers
with some rare new color –
she repacks her box to leave,
each wisp grown a shade lighter
and I carry a pastel weight.
. . . . . . .
The Geriatrician Ages
They don’t fly up at him, all these names,
no confusion of pigeons’ wings
in the parking lot; they don’t lock arms
to block him entering
the next exam room;
maybe they awaken him near dawn
but not by shaking. More like
the powdery flutter
of a moth disturbed in daylight,
the mute gray snowfall
of ash from burning newsprint.
Many he can’t recall, but all of them
he recognizes when dry lips
whisper their presence
from the other side –
not accusations (their ease of passing
one more benediction
of his calling), not really thanks
though most are grateful,
mostly just an airy I . . . I
in his cluttered bag of memories.
So many, so often now, more and more.
Each murmur a spirit body bowed
into a wheelchair, curled mantis-like
in bed, pushing against a walker,
each of them pushing, pushing
against what held them here
and what let them go.
Some days he can’t remember
if he last saw them on evening rounds
or in a dream, and any moment
he expects the office door to open:
one will enter, speak
his name, one he had thought
was gone.
. . . . . . .
Care was first published in Mobius, Vol. 2, Nr. 20, Fall-Winter, 2006
The Geriatrician Ages originally appeared in Journal of the American Medical Association, Vol. 304, No. 16, October 27, 2010, and is also featured in my March 17, 2012 post
Both of these poems are collected in Crossing the River, Main Street Rag Publishing, © 2017
. . . . . . .
Jonesville Family Medical Center — Yadkin County, NC — 2008
The JFMC Christmas Party of 2010
. . . . . . .
V E R S E and I M A G E 
We all need to pay attention to those reminders daily. ---B