The Late Patient

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John Davenport, MD, JD¹

Perm J 2019;23:19.075 [Full Citation]

https://doi.org/10.7812/TPP/19.075

E-pub: 09/05/2019

She 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 Statement

The author(s) have no conflicts of interest to disclose.

How to Cite this Article

Davenport J. The late patient. Perm J 2019;23:19.075. DOI: https://doi.org/10.7812/TPP/19.075

Author Affiliations

¹ Department of Family Medicine, Southern California Permanente Medicine, Irvine, CA

Corresponding Author

John Davenport, MD, JD (john.y.davenport@kp.org)

Keywords: narrative medicine