Intimacy in family medicine
Jen DeVoe
The work of family medicine is often an intimate one. Why? Because working with patients means a closeness of spirit, hope and—inevitably—loss.
A few weeks into the COVID-19 pandemic, I logged into a virtual visit with my 80-year-old patient Henry. He was to see me for a preventive health visit following a gruelling but successful 18-month battle with lymphoma. His cancer was in remission.
I expected our conversation to be one of celebration. Instead, I learned his wife of 61 years was dying of pancreatic cancer. I did not know what to say. After fumbling my way through a few condolences, I managed to ask Henry how he was doing. After a long pause, he responded.
‘My wife is dying right before my eyes, and I can’t do a damn thing about it.’
I learned that Henry’s wife had recently entered hospice and that all her care was virtual; no one was visiting due to COVID precautions. I recommended we schedule routine calls for blood pressure monitoring; these calls would give me a chance to talk with him regularly.
At our next call, after briefly chatting about his blood pressure, I again asked, ‘How are you doing?’
Barely audible, he stammered, ‘I can’t live without her. My heart is broken.’
Henry and I had a few more calls during his wife’s last weeks of life, and then she was gone. When he called to inform me, I could hear in his voice that it was the beginning of the end for him.
I recommended we continue our follow-up calls, mostly so I could offer Henry grief support. He declined all other services. When it was safe to return to in-person visits, I saw Henry in clinic. We hugged, and he whispered in my ear, ‘Thank you, Dr. DeVoe. That is the first human contact I’ve had in six months.’
Soon after, Henry started falling, alone at home, late at night. Many mornings, upon opening my electronic medical record, I saw his name on my list of patients on our hospital service, for lacerations, broken ribs, and compression fractures. Our routine clinic visits became regular hospital visits.
When I recommended that Henry consider moving to an assisted living facility, he politely told me he would never leave his home—a move would dishonour the memory of his wife. Our team scheduled home health services and strategized on ways to offer support. Eventually, a home health nurse informed me he had died at home.
When his death certificate arrived in my mailbox, I paused before writing ‘undetermined cause of death’ in the appropriate space. What did I really want to write? ‘Cause of death: broken heart.’
Every time a patient dies, a jumble of emotions fills my mind and my soul. I am grateful to have had the privilege of being the personal physician to these patients, now deceased. I also often struggle. Did I achieve the right balance between working to keep patients alive and helping them die with grace and dignity? Such is the nature of my work in family medicine. Sharing professional intimacy with patients opens the door to many joys; there also exist the inevitable challenges inherent to any close relationship (figure 5).
Figure 5Intimacy: human caring made ‘real’.
Readings
Woodruff A. Keeping the family in family medicine. Am J Hosp Palliat Care 2021;38:313–4. doi: 10.1177/1049909120933273
Byock I. Suffering and wellness. J Palliative Med 2009;12:785–7. doi: 10.1089/jpm.2009.9568
Yeo M, Longhurst M. Intimacy in the patient-physician relationship. Committee on Ethics of the College of Family Physicians of Canada. Can Fam Physician 1996;42:1505–8.