Stories in family practice: Part 2: Patients’ needs at the centre (continued from May 2006)

Despite 75 years of what he believed was a wonderful marriage to the woman he still described as “the passion of his life” and “as beautiful as the day we met,” my new 97-year-old patient was resolute in his conviction that, if his life partner would not accompany him to England so that he could die and be buried there, he would have to leave her. As he finished telling me the story of his life and explaining why he was making this difficult choice, he agreed it was time for me to meet Mother. A very beautiful and graceful 95-year-old woman entered the room. She stood about 5 foot, 4 inches. She had a shock of luxurious white hair and was obviously both fit and agile. Her charm, intelligence, and wit quickly became evident. But her most marked feature, visible from the opposite side of the room, was a large purple bullous hemangioma that covered the left side of her face from forehead to chin. She later told me how this “birthmark” had accompanied her throughout her life, becoming more obvious and misshapen in her adolescent years. I could feel a chill go down my spine, thinking of how her husband had described his first meeting on the ship, when she was 16, with “the most beautiful girl he had ever seen.” If I didn’t already know that love was much more than skin deep, I surely learned it at that moment. Mother described her wonderful relationship with her husband and the Canadian family they had raised. She recalled the many medical challenges she and her husband had faced and overcome, including complications with the birth of children, life-threatening infections, and serious accidents. She talked of how their old family doctor had been their friend and caregiver, and how they had survived by learning to care for one another. Their early years predated most of today’s vaccines and antibiotics. Home care was the family doctor and some wonderful visiting nurses. Hospitals were not a major part of their care, and they still saw them as centres where people with dreaded diseases like tuberculosis and polio were treated — and as pretty scary places where you might catch things from these really sick people. Mother was very frustrated by Dad’s recent insistence on leaving his life in Canada behind so that he could return to England to die. She believed he was probably “going senile” and needed help to clear his thinking. She feared he showed no sign of listening to her attempts to reason with him. They both asked me to carry on as their new family doctor; their children and grandchildren were already my patients. I saw them each once in my office and then visited them at their home every 2 weeks for what they described as marriage counseling. We focused on their histories in England and Canada and their lives together as part of the large family they had built in Toronto. We pored over photo albums. We had one session with family and a few neighbours. Throughout every session, Mother and Dad sat on a sofa holding hands and looking lovingly at one another. In the end, resolution of the problem turned out to be easy. Dad began to realize that his life and memories were really all in Canada and that he needed to remain close to the family and friends who defined his past 79 years. Although he had temporarily lost his focus, he came to understand that this was where he should live the rest of his life and this was where he should be buried. In life and in death, he simply could not ever be apart from Mother, the beautiful person who had been his life partner for 75 years. They went on a few more years, suffering a series of medical problems, but had no further relationship conflicts. They are both now deceased and are buried in the Toronto area. The unique challenge of providing marital therapy for a couple in their late 90s provided me with a lasting memory. What I have done to help them was insignificant compared with what they taught me about the importance in our lives of love and family — and of how fortunate I was to be a family doctor. Experiences like these remind us of what family medicine and our principles really mean: that we family physicians are skilled medical doctors who contribute our expertise to ongoing relationships with our patients. In those relationships, all problems that patients bring to us — be they large or small; simple or complex; clinical, psychosocial, or spiritual in nature — are addressed with patients’ needs always at the centre. It is because family doctors support their patients through so many problems that their medical skills can be applied so effectively and they can build the trust critical to producing the better health outcomes that studies have shown are associated with primary care by family doctors. Family doctors everywhere have experiences like these to share. They help us and those around us better understand who we are and why we are so highly valued by our patients. They remind us what a privilege it is to be a family physician. We want to collect these stories and, through them, build our history. If you have a story, please send it to us at ac.cpfc@ofni.

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