“Margery* is here to see you, Doctor.” Aged 78, she was one of my regular patients with chronic obstructive pulmonary disease, at the office again, requesting to be fit in the schedule. Today, there was a subtle difference in her presentation. She had always seemed to bounce back after short courses of steroids and inhalers before but not this time. I listened to Margery’s lungs. The sounds were abnormal. She had reduced air entry on the right, and a chest X-ray later revealed a suspicious shadow in her right bronchus. Lung cancer was subsequently confirmed. It proved inoperable. I called Julie, our McMillan palliative care team nurse. She was immediately supportive in her response and fully understood the situation.
My medical student and I later visited Margery at home several times in the following three weeks to assess her. Her welcome touched us each time in both sentiment and emotion. Still, with sparkles in her eyes, a smile, and a greeting, it was apparent that her brightness was fading with each visit.
The care of Margery highlighted the importance of synchronizing continuity of care, proper use of healthcare resources, interprofessional collaboration with nursing and pharmacy, teaching, and the intrinsic experience of patient-doctor relationships to form a well-rounded care plan for her. Our nurse receptionists identified Margery’s deterioration on her arrival at the office. Their training enabled swift referral of patients with more urgent needs than apparent at first sight for urgent care visits. Nurses, pharmacists, social workers, and family members all had input in every step of her care.
Margery decided to stay home with her husband, Bill*, and not advance care. That decision enabled her extended family to visit freely and be involved as caregivers during her final days, supporting her wishes fully.
And the outcome? On her penultimate day, Margery, a longtime patient, said softly, with direct eye contact, “Sorry to have been such a bother to you, doctor, and thank you for looking after me.” While being lost for words, she raised beckoning arms for a final embrace. Tactile contact often moves one to emotion when responding. She was a daughter, sister, wife, mother, and grandmother, and she was my patient. It felt as if I was losing an old friend. After pronouncing her death, her husband thanked me for his wife’s care, taking my hand with both of his with a warm, prolonged shake as we looked at each other. Facial expressions conveyed all the emotions at that moment. There followed unforgettable words after he looked into my eyes, “Are you alright, doctor?” in a soft voice with a clear tone. If ever one could confirm the value of the profession of a family physician, this was a pivotal moment. His words dispelled any hesitation as we consoled one another with a spontaneous embrace. His words, sense of gratitude, and compassion towards me were priceless in that moment, and he reminded me of the importance of primary care.
Family medicine thrives when one can delve into the unspoken hidden curriculum that we often shy away from. Does one always have to have emotional control? Does one need to keep at arm’s length all the time? Can a doctor cry with a patient and their family? Throughout the years of training, does one ever prepare for such a day? Being a family physician at that moment is an experience that carries both privilege and humility.
My medical student started to ask me more about family medicine when we returned to the office. During his four-week clinical rotation, he had begun to hesitate about pursuing a career in internal medicine. He wanted to learn more about a family medicine career and asked if he could arrange a future elective. Indeed, a potential doctor in training who resonates with my own sentiments about this career.
Author’s note: All names have been changed to protect the identity of the deceased patient.
Image credit: Globe and stethoscope on white background by focusonmore.com is licensed under CC BY 2.0.
Physician Contributing Writer
Weill Cornell Medicine, Qatar
A practicing family doctor, and academic family physician, Dr. Verjee initially qualified as a biochemist. Later as a medical graduate from the University of Dundee, Scotland, he completed postgraduate training as a general practitioner in England. He first started teaching medical students at Oxford University, from 1979. Migrating to Canada in 1994, he spent two years in Newfoundland and Labrador in Wilfred Grenville country before moving to Alberta, Canada. Joining the University of Calgary in 1997, he established a career in academic medicine before taking up a new faculty position in Qatar at Weill Cornell Medicine's international medical campus in 2007. He completed an MBA (Leadership & Sustainability) in 2016. An Associate Professor of Family Medicine in Clinical Medicine, he is an alumnus of the Harvard Macy Institute, Boston, United States, a Senior Research Fellow in Psychiatry at Clare College, Cambridge, United Kingdom, and a TEDx presenter. His widespread interests include endocrinology, women’s health, vaccination and immunization, diabetes mellitus, preventable blindness, narrative medicine, and poetry. Music, both classical and hard rock, and playing his cello are part of his life.
