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.

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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.


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