“Doc, I want my brother to marry you so you can be part of my family.” My patient told me this right before she left after a routine visit for knee osteoarthritis. I felt tears in my eyes.
I was particularly touched because this patient has terminal lung cancer; even though I have little to offer medically, I keep seeing her because I lack the courage to tell her she does not need to come back for follow-up visits. I am afraid she would feel as if I was giving up on her.
When I entered the examining room, she was lying on the exam table looking very sick, but clearly eager to see me. We talked about her struggles with chemotherapy and with her daily chores, an increasingly demanding burden since she lives alone and feels very weak. At this point, there is little to do about her knee pain, and she understands it. Still, she told me she would like to control her pain enough to be able to fly to the West Coast to see her son. When I asked her why he would not come visit her, she simply said, “Because he is in jail.”
I was at a loss for words. She noticed my embarrassment, gave me a half smile, and we just stood there looking at each other the way mothers do when they are worried about their children. Suddenly, I realized that I should not allow personal feelings to take over and started reviewing, if somewhat awkwardly, her use of pain medications. The emotional moment was broken; she was again my osteoarthritis patient.
After she left, I saw other patients for whom I had to decide whether to start or change complex medications, monitor their drug toxicity, or dispense advice on how to prevent cardiovascular disease. This is the easy part of our practice. As challenging as these medical decisions may seem, evidence-based information and data we can readily use are as close as our tablet screen. How to comfort the dying mother of a faraway inmate can only be found within ourselves.
Marcia S. Genta, MD
Dallas Arthritis Center
Dallas, Texas
