The Late PatientJohn Davenport, MD, JD1 Perm J 2019;23:19.075 [Full Citation] https://doi.org/10.7812/TPP/19.075E-pub: 09/05/2019She came in overdressed, over perfumed, and 30 minutes late to the last appointment of an evening clinic, which was scheduled to close at 9 pm. “The perfect ending to a 14-hour day,” I thought as I listened to her tell my nurse that she couldn’t get off work early and she had to be seen. She had a “cough.” “Oh well, easy enough,” I thought. I introduced myself and took a brief history: 2 weeks of a cough, she didn’t smoke, no blood with her cough, no fever, no weight loss—looking good. A perfunctory physical was normal. I was just starting my “watchful-waiting-with-reassurance” speech when she interrupted. “I know my body,” she said. “I need a chest x-ray.” Fatigue and the obstinate set of her jaw made me take the path of least resistance. “Sure,” I said. “And can you read it tonight? I’m traveling to my daughter’s wedding tomorrow.” I’d already retreated from 2 skirmishes with her, so why not make it a rout? “Of course,” I said. Waiting for her to return from x-ray, I spent the next 30 minutes flipping through a journal I wasn’t interested in and wondering if I should eat a full meal when I got home or defer to my heartburn. When I heard my nurse greet her in the hallway, I hurried out to intercept, tell her the obvious, and slip out while the nurse finished her discharge. I took the envelope (before digital days) and slammed the film onto the view box so that we could look at the film shoulder to shoulder, only to see a constellation of metastatic stars covering the dark sky of her lung fields. “What are those?” she asked, pointing at the film. I was suddenly ashamed of my self-pity over a 14-hour day, ashamed of my cursory exam, ashamed of my rote diagnostic assumptions, and ashamed of my selfish hurry. What could I say to a woman at 10 o’clock on the night before she was supposed to travel to her daughter’s wedding? The seconds were ticking away as I tried to find the right words to start with, when I felt the gentle touch of her hand on my arm and her words, which were spoken with more empathy and understanding of me than I’d ever shown her: “Don’t worry, Doctor. It will be okay.” Disclosure StatementThe author(s) have no conflicts of interest to disclose. How to Cite this ArticleDavenport J. The late patient. Perm J 2019;23:19.075. DOI: https://doi.org/10.7812/TPP/19.075 Author Affiliations1 Department of Family Medicine, Southern California Permanente Medicine, Irvine, CA Corresponding AuthorJohn Davenport, MD, JD () Keywords: narrative medicine |
ETOC
Click here to join the eTOC list or text ETOC to 22828. You will receive an email notice with the Table of Contents of The Permanente Journal.
CIRCULATION
2 million page views of TPJ articles in PubMed from a broad international readership.
Indexing
Indexed in MEDLINE, PubMed Central, EMBASE, EBSCO Academic Search Complete, CrossRef, and SciVerse/Scopus.