My assignment was to write a reflection on the experience of having, or not having, a longitudinal geriatric patient. I wrote this. It's probably not what my teacher wants.
My patient, EN, was overall a very healthy 81 year-old at our first meeting in April of 2008. She had also recently been diagnosed with SCLC in January of that year, as an incidental finding on CXR taken when she was in the ER for a pulmonary embolism. When I first spoke to her, she seemed to understand what that diagnosis implied, but was resigned to everything her future had in store – especially in light of having been a “heavy smoker” in her youth and middle age. However, she was quite upbeat throughout the interview, joking about family members and friends in the residence in which she and my preceptor lived. I was also able to create a good rapport with her because she was friendly and welcoming, and because we shared a love of travel – hers evident in the world photographs on the walls of her apartment. For a few moments after the H&P was over, we had a chance to talk about Africa, where I had spent two years as a Peace Corps volunteer and a few months as a researcher. She had been to South Africa recently, saying that after Apartheid ended, she “just had to go”. And that people in her generation never thought they would “see a free South Africa”.
EN clearly valued family and spoke fondly of her daughters, but was too independent to follow them to the cities in which they lived. Instead, she spoke of traveling with them. At our third visit, EN told me she and her three children had traveled over the Christmas holiday to the home in which she grew up in Connecticut. It was something she had long hoped to do; I got the sense that having accomplished that visit, EN felt that much closer to a peaceful death.
My visits with EN were not free of awkwardness. Knowing something about the prognosis for SCLC, I never knew exactly how to ask about EN’s plans for how she would maintain her health, which was necessarily unsteady. I said goodbye not knowing if I would be able to greet her again. On our third visit, EN was hooked up to an oxygen tank, which was out of sight in her room as we talked in the living room. The cannula snaked around the coffee table and back through the doorway. I tried to appreciate the freedom that the device allowed, rather than concentrate on the loss of function that it signified.
My preceptor wrote me that EN died a few months after it happened. He told me he’d spoken at her memorial service, and told everyone that she had insisted on following up with the medical students whom she’d begun to see despite its increasing difficulty. I appreciated this, and, strangely, didn’t feel sadness, exactly. I felt the loss of a strong and unique person, and I imagined the photographs being taken down from her apartment by her children and the oxygen tank returned to the hospital or medical supply unit. But it occurred to me that sadness is a syrupy emotion, provoked by displays of pathos. EN, never wishing to be anyone’s victim, never projected that. She resisted portraying herself as weak and incapable, choosing instead to relate to others on the basis of shared interests and ideas. She will be missed, but never whimpered over.