Letting Me Off the Hook

Letting Me Off the Hook


James T Hardee, MD

Perm J 2018;22:13-116 [Full Citation]

E-pub: 01/22/2018

This is a story and illustration from the upcoming book 100 Little Stories of Big Moments published by The Permanente Press.

The stories were written by clinicians in 15 minutes in writing workshops about meaningful moments in their work and life of practicing medicine. Professional artists were asked to create a visual representation of the story.

Margaret was 82 years old and had a plethora of usual and not-so-usual medical conditions. Diabetes, hypertension, congestive heart failure, arthritis, and GERD to name a few. She also had a Pacemaker and an artificial knee. I would see her 4-5 times a year for various ailments—some new and others chronic. Fatigue. Dizziness. Back pain. Shortness of breath. Tingling. Numbness. And so on …

While I always thought she was a “nice lady,” I would at times find myself frustrated because most of her ailments were not fixable. There was no  “cure” for her back pain. The fatigue was so multifactorial that no intervention would likely help much. I found myself occasionally annoyed during some of her visits, wanting to say bluntly, “You’re 80 years old with a problem list a mile long and on 13 medications … what do you expect?” I wanted, just once, to call it out and state the obvious. But I never did.

At the end of one particularly long visit with her, while I felt the usual exasperation, she commented something that has stuck with me ever since. “Dr Hardee, you never fix me, but I always enjoy talking with you!”

This was the break in the case I needed. This gave me relief and the permission that it was “okay” not to fix her. There was benefit to our meetings beyond labs, x-rays, injections, meds, and referrals.

That she enjoyed the interactions let me off the hook, as it were, and helped me not feel quite so obligated to try to fix her. I found myself enjoying her visits more, since knowing the “goals” of care were looser … more negotiable.

I use her quote from time to time with other patients in similar situations now to reprioritize and recognize what I can and cannot do.

Letting Me Off the Hook

How to Cite this Article

Hardee JT. Letting me off the hook. Perm J 2018;22:13-116. DOI: https://doi.org/10.7812/TPP/13-116

“Letting Me off the Hook” was originally published in leaflet, v4 #2. Available from: http://leaflet.thepermanentepress.org/2012-09-07-07-54-29/volume-4-issue-2/item/letting-me-off-the-hook?category_id=65.

etoc emailClick here to join the eTOC list or text TPJ to 22828. You will receive an Email notice with the Table of Contents of each issue.

The Permanente Journal advances knowledge in scientific research, clinical medicine and innovative health care delivery. It is a peer-reviewed journal of medical science, social science in medicine, and medical humanities.

The Permanente Press

The Permanente Press publishes The Permanente Journal and books related to health care. For information about subscriptions, missing issues, billing, subscription renewal, and back issues, Email: permanente.journal@kp.org.


27,000 print readers per quarter, 15,350 eTOC readers, and in 2018, 2 million page views of TPJ articles in PubMed from a broad international readership.


The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ISSN 1552-5767 Copyright © 2019 thepermanentejournal.org.

All Rights Reserved.