It is a privilege to be present with our patients, even during times of pain and loss. Meaningful connections, like those that naturally emerge during house calls, provide space for important decision making, comfort, and hope.
When I was a first year medical student, I went on my first house call with Dr. Andrea Fox, a geriatrician at the University of Pittsburgh School of Medicine where I trained. Together we walked four blocks and up three flights of stairs to see her patient, Mrs. A – an older woman, thin and frail with wispy white hair, bedbound from end stage dementia, confused, lying in bed with her anxious son at the bedside.
Dr. Fox assessed Mrs. A, quietly soothing her as she listened to her son describe his mom’s sudden decline in health. She listened and nodded as Mrs. A’s son described his fear of losing her, and his desire to keep her at home and away from the hospital. Dr. Fox looked at photos in the room, laughed at the stories of his spitfire of a mom, and reassured the son that he was thinking about all the right things.
She examined his mom carefully, and then asked a few open-ended questions and just listened as Mrs. A’s son told us about who his mother was and what she would have wanted. By sitting with his grief, they were able to make a plan for how to keep her at home, as comfortable as possible, for the days she had left.
I can still remember so vividly how it felt to be in Mrs. A’s bedroom as I was learning to be a doctor, everything still new and raw. There was so much to learn that day, but there are three lessons that I came to understand better over time.
1) It is the human connection, the being present with the pain and the loss, which creates space for hard decisions, comfort, and hope.
Dr. Fox’s communication skills and ability to connect with Mrs. A’s son at a sad and difficult time were not “soft skills,” but rather they were essential components to delivering the best possible medical care to a frail, vulnerable, older woman nearing the end of her life.
2) There is always room for hope.
Even as Dr. Fox told her son honestly and gently that we likely wouldn’t be able to make his mom better, there was still hope for comfort, hope for dignity, hope for joy in the story and celebration of her life, and hope for peace.
3) With great privilege comes great responsibility.
It was clear from listening to Mrs. A’s son that they had too many unmet needs beyond what our medical care and our presence could provide, and that these unmet needs were leading to poorer health outcomes for both of them. We must work tirelessly for medicine as social justice – to bring care to patients who are vulnerable and marginalized and to build a more equitable and just society for the benefit of all of us.
On our walk back to the hospital, we talked about all of these things – what it means to provide medical care as a guest in a patient’s home, how to help caregivers shift the focus to comfort at the end of life, and what we can do as physicians to make the system better for our patients. I continue to carry these lessons with me into my own work as a geriatrician, remembering the honor that it is to be part a patient’s life story.