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Posts Tagged ‘Geriatrician’

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?

 

 

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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.

 


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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.

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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

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Jonesville Family Medical Center — Yadkin County, NC — 2008

 

The JFMC Christmas Party of 2010

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“As needed?”

When I left the hospital last Saturday night a fat Vidalia moon was just peering through the trees that circle the campus.  There were two cars and a pickup in the visitors’ lot.  Lined up on the front bumper of a dented black Civic were three of those deer blasters, chrome-plastic gizmos four inches long that look like little jet engines.  When you’re driving sixty they’re supposed to emit an ultrasonic whistle that spooks the deer so they don’t jump in front of your car.  Gives you an idea of the kind of traffic concerns we contend with out here in Surry County.

As I crossed to the lower lot (there was only one car at the far end – mine) I glimpsed movement.  I stopped and turned.  A grey fox trotted across the pavement.  Ignoring me.  It sauntered into the bushes at the perimeter of the landscaping and never made a sound or quickened its step.  Time to spring forward.

The big trees are still bare but this week the cherries blossomed.  Canada geese in the hospital pond have paired off.  Sunday morning I saw a pair of hooded mergansers and a wood duck eyeing each other near the nesting boxes I donated a couple of years ago.  How long until fuzzy chicks leap unafraid from the nesting cavity and plop into the water like tennis balls?  Everything is precisely as it should be.

What is needed?

Some day soon – five years?  ten? – I’ll make evening rounds for the last time.  There are plenty of things I’ll miss.  The Monday mornings after a long weekend on call.  Clowning around with the nurses – walk the halls with a big mug that says “DUKE” if you want to start a civil war.  My partners: sitting down to puzzle out a confusing patient; cracking each other up with the deadly black humor that makes you shut the door of the conference room.  And of course my patients.  Figuring out what they need and being right a lot of the time.  Figuring out who they are.  Figuring out who we are together.

And I wouldn’t even mention that there are plenty of things I won’t miss, except that they fall into the category of things-that-piss-me-off and are mostly the same for everyone who has survived into the twenty-first century: mindless productivity-sapping bureaucracy; people that manipulate and take advantage of you; being unappreciated, or underappreciated.

But there’s one more thing I really won’t miss.  Although it makes me irritable (ask Brenda and Carolyn at the office), it isn’t having to think about ten things at once – adrenalin just primes the pump, after all. It isn’t even the 3 a.m. calls from worried mothers – hell, that’s what I signed on for.  And it isn’t fear, although there have been plenty of crisis situations when I’ve been scared, and I don’t like that.  That thing I will be most glad to put behind me is something I might name “malignant uncertainty.”  I don’t know what comes next, I’m not sure what to do, but if I don’t make a decision in the next thirty seconds something real bad is going to happen.  Close corollary – I’ve given the order, the die is cast, and now I will sit and watch the outcome for minutes, hours.  Will this baby’s breathing slow to normal?  Will this old woman’s blood pressure come back up?  Will somebody hold my hand?

What do I need?

Besides another weekend off?  A couple of hours to write these lines?  An insight bright enough to make sense of it all?  A moon that pours through the branches while the fox and I pause to listen to spring peepers?

Will I figure it out before I’ve missed it?

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Painted Trillium

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The Geriatrician Ages

They don’t fly up at him, all these names,
n
o 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 their 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.

.     .     .     .     .

first published in the Journal of the American Medical Association, Vol. 304, No. 16, p.1754,  October 27, 2010

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