What I Do and Why I Do It: A Palliative Perspective

I am today a family physician.

One who happens to be full-time faculty at a Family Medicine residency, adjunct clinical faculty at the University of Iowa’s medical school, currently Associate Program Director, and, as of seven months ago, the residency’s Program Director. And, in addition to being Board-certified in Family Medicine, I am also now Board-eligible in Hospice and Family Medicine.

But so much for all that medicine stuff.

Because, the thing is, I didn’t need to be a physician to make me who I am. Let alone to make me the Palliative Medicine physician I have become.

Life, in fact, was my only preparation for both.

My mother, dead at 49 of breast cancer; my father, dead at 66, himself of pancreatic cancer; me, my bride, then of only months, then suddenly helping me to raise my 11-year-old brother.

And don’t ask me to tell you about my father’s brothers, lost in their 20s, accidents both; his mother, dead of cancer in her 40s; her own mother, killed even younger; yes, by cancer.

For my part, I didn’t go to medical school until I was 49 years old, finally fulfilling a long-held dream that had also come to include being a country doc in Vermont, where we then lived (that I remain in Iowa, teaching residents, doing Palliative Medicine is a tale for another post).

Before that, in my previous career, I had been a writer, penning books on behalf of the likes of Time-Life Books, National Geographic and Reader’s Digest, in addition to writing advertising copy for those companies and many, many others.

But all that was then. And this is now.

And now, as part of my faculty duties, I see palliative patients two half-days per week.

Those half-days are always unpredictable, in terms of how many new consults, how many follow-ups, how long any one of those encounters might take.

Not to mention how amenable to Palliative Medicine any one patient—or his or her family—might be. Or what we, from a palliative perspective, can possibly do for that patient, that family. What family dynamics might be in play, especially—very especially—at the end of life.

What I do, however, to the best that I can do it, is always good.

Always rewarding.

And always, considering with whom I work, in good, very good, company.

And even on those days, when the day is nothing but death and dying, I am myself, in the end, good, even if it means a single hour at the end of the work day by myself, in silence, in a favored living-room chair, my bride of these, now 30-something years, Karen, knowing what she has come to know: that this hour usually undoes what has been done.

Nothing that I did in medical school prepared me for what I do now, at least in terms of Palliative Medicine.

Nor did any one moment in residency prepare me for this, with, perhaps, this, a single exception.

A woman who suffered a stroke, then fell to the floor in the bathroom, against a baseboard heater.

Was burned as a consequence, only to then have a heart attack, even as she lay there on the bathroom floor, eventually, blessedly, arriving at a local hospital, with me, by chance, the resident then on duty.

Never before, in rounding on the mornings following, had I seen so many family members in a hospital room, and never before so many family members, so loving.

And me then, doing what I could do, little medically, mostly holding hands collectively, even if, given so many family members, hand-holding by air, as Sylvia, days or a week later and surrounded by family, let go of life.

A couple of years later, I’m dropping off a package at the FedEx station at the local airport.

The clerk, a young woman, sees my name on the hospital badge dangling from my shirt placket, recognizes it, says, “I remember you. You took care of my grandma. Thank you. Thank you.”

No. Thank you.

Because I owe you, owe your family.

Because I learned more about love from you and your family. A love I to this day remember.

Learned what it means to be so loved; to live a life that mattered to so many; to have that life lost to those there, to those who couldn’t be there.

What that granddaughter didn’t know was that due to residency responsibilities I had been unable to attend her grandmother’s funeral, even though I had wanted to. But that Karen and I did a week, a two later, drive out to a small town here in eastern Iowa, to find the cemetery, to pay our respects. Karen and I standing a while on a rise in that cemetery, Karen beside me, knowing that I knew what she couldn’t fully know.

What I do, I do in part for Sylvia, for her family, for those loved her so much, for what they taught me, what I now teach others.