Stories in family practice: Part 1: Living the principles of family medicine

Few who attended will ever forget the keynote session at Family Medicine Forum 2005 where Rob Wedel and several of his family physician colleagues shared stories of their experiences in family practice. Regular readers of “Reflections” in Canadian Family Physician have expressed their appreciation to contributors whose stories deliver powerful messages about the meaning of being a family physician and about the challenges, joys, and rewards that are part of our specialty. When compiled, these stories also help describe the history of family medicine and the important role it has and will continue to have in the health care and social fabric of our nation. Rob and his colleagues are encouraging our College to collect as many stories in family medicine as possible to enable us to preserve our past and inspire our future. If you have a story, please send it to us at (ac.cpfc@ofni). The following, which took place in the early 1980s, is but one of my own stories. I always found my elderly patients an incredible source of inspiration and information—about medicine and about life. They often presented with challenging medical problems, diagnosis and treatment of which reminded me why I spent all those years studying and training to be a medical doctor or (as we say in one of our principles of family medicine) a skilled clinician. Getting to know our elderly patients over time, caring for their small and large medical concerns, and understanding them as people and not just as diseases or body parts, we learn to adapt our medical management to ensure the best possible approach for each individual patient. We cannot help but incorporate some of what we learn from these patients into our personal and professional growth. This aspect of practice exemplifies the principle of family medicine that focuses on the centrality of each patient and each patient-doctor relationship to all we do. I had been caring for a family for several years, a brother and sister in their 70s and their spouses, children, and grandchildren. One day, the brother and sister called to ask me to assume the care of their parents, whom I did not know, and who had recently lost their own family doctor. Dad was 97 and Mother 95. They had been married for 75 years and were suddenly not getting along; Dad was threatening to leave his wife. The family was at wits’ end, thinking that Dad was probably exhibiting signs of some kind of “senile dementia.” They had tried to intervene to no avail, and they asked me to try to resolve this problem. It was winter, and the couple did not get out much, so I agreed to visit them at home. It was early evening, but the December skies had already left Toronto’s west end in darkness. The modest red-brick bungalow of my new patients was brightened only slightly by a single bulb defining the front door of their snow-covered porch. I was greeted by Dad, who welcomed me warmly, and said he would see me alone before I met his wife. He was an engaging, very bright, and articulate gentleman who stood about 5 foot 10 inches and had a head of white hair that, despite his being almost 3 times my age, was triple the thickness of my own. He walked with a slightly stooped posture and shuffled a bit. He occasionally used a walking stick for balance. Over a cup of tea, he poured out memories of his life as a child in England through his turn-of-the-century voyage at age 18 across the Atlantic to seek work in what would become his new homeland, Canada. He spoke of his training as a civil engineering apprentice, his years of hard labour, and how he had eventually become head of the engineering department for the City of Toronto. Most of his conversation was about his family and the fulfilling life he had had as a husband, father, grandfather, and great-grandfather. His health was excellent—other than some degenerative arthritis in his hips and lower back and occasional exertional dyspnea. He took no medications, and other than a shot of sherry before dinner and an occasional cigar, did not drink or smoke. His passion was his wife. He described how they met, the kind of “love at first sight” romantic story that sells dime novels and sometimes actually happens. He reminisced about the moment he first saw her on the ship coming over from England. Though she was only 16 years old, she was “the most beautiful woman I had ever seen.” He described their courtship and marriage 2 years later and the subsequent 75 years that he felt had “flown by.” He said he owed everything in his life to his wife who had given birth to, raised, and nurtured their 3 children, and him, through thick and thin with never-wavering love. Yet he was now suffering great despair because even she would not support something he felt had to be. He saw the end of his life nearing and decided it was time to return to England to die and be buried close to his parents and ancestors and the long line of English kings and queens that meant so much to him. His wife steadfastly refused, saying their offspring and lives were in Canada and that was where she, and her remains, would stay. He decided that, if this was her final position, he would have to leave her and head back to England on his own. If necessary, he said, he would seek a divorce.

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