This week we have a reflection from Melissa Rathmell who is faculty and Director of Integrative Medicine
at Family Health Center of Worcester. She writes about the power of having only one interaction with a family and the implications it had. I am sure many of us have had similar brief encounters that felt greater than the amount of time spent. See what you think.
You can send comments to Melissa at Melissa.Rathmell@FHCW.org or to the listserv directly. Enjoy.
I only saw her once
She was a frail, elderly woman who spoke only Spanish and seemed to be wearing skin that was made for someone just a bit larger. She was frightened. She was here with her daughter, who was her primary caregiver, (as 4 of her other children were estranged, and one was not local.) The appointment was made because she “didn’t have any appetite anymore.” I learned that she had been a vibrant, active woman who worked as a housekeeper in her beloved Puerto Rico until about 15 years ago when she was diagnosed with Alzheimer’s disease. She moved to MA with her daughter to get better care when she was diagnosed with colon cancer about a year ago. She was non-verbal with me, but communicated so much with her eyes. She didn’t want to eat more than a bite or two. She had lost 20 lbs in the past 6 months.
Her daughter and I talked about end of life care. What were the patient’s wishes, goals, plans? What were the daughters? We talked about the process of dying. The normal changes that happen. I suggested hospice, visiting nursing, and home services. The daughter wanted none of that. She wanted to do it herself. We talked about DNR, DNI, and CMO. The daughter agreed that those all seemed right. I held the patient’s hand. I told them I would be there for anything that they needed.
They later agreed to have a visiting nurse to help them out. My brilliant office nurse set them up with a company that does not only visiting nurses, but hospice too. The notes said they talked about hospice and what that means. She declined. She became unresponsive. They agreed to hospice.
She died peacefully at home the other day. In comfort and dignity. The way she had lived. The way she wanted to die. The way her daughter was comfortable with.
I only saw her once. I think I made a difference. I hope I did at least.
The Thursday Morning Memo is intended to complement the Monday Memo and usual list serve communication by providing communication of "clinical success stories" within the Department. Feel free to post responses to these stories on the listserv, realizing that they will first be directed through Hugh Silk, the Thursday Morning Memo moderator. Please note that all submissions, original stories or responses, must be free of HIPPA identifiers to preserve confidentiality.
If you wish to submit an item to the Thursday Morning Memo, please email it to Hugh Silk. Please write the Memo as a short essay, reflection, poem or story about your clinical/teaching success (keep it to one page). Please de-identify the patient or learner. Please ask the patient or learner if it is OK to write about them.