I came across a letter written by my mother’s physician after her death, post-stroke, and post pulmonary embolism while being med-evaced by air to Seattle (and the ensuing drama and heartache while unexpectedly on the ground in Bismarck, ND, where she died). He was her primary care physician for 27 years. His technical expertise and deep compassion exemplify the best that medicine has to offer. The letter and my mom’s death were in 2001, so seeing the letter took me back.
In the letter, he expressed not only his own sorrow, but a deep knowledge of my mother and her personality, intelligence, quirks, and values. In the letter, he expressed deep empathy with the decision to discontinue life support. He knew that this was what she wanted in a circumstance of medical futility, as expressed in her advance directive (Living will). I came across situations that were virtually identical in my years as Chief of the Clinical Ethics Consult Service at one of the Seattle hospitals. Never, though, did I encounter a situation where a physician was so empathetically tuned into the deepest values of the patient, or expressed such a profound knowledge of the patient’s deepest hopes and wishes.
Can this happen 17 years later in the era of 10-15 minute visits? One study showed that the actual median face to face time in family practice is 6 minutes. Is it possible to really know a patient in the way that Mitch knew my mother? Many of the technical details in medicine advance. A comment that I frequently hear in the corridors of the School of Medicine, and in our teaching hospitals (and at Grand Rounds) is “I want to get to know my patients better, but the rushed visits, and all the attention needed for the electronic health record make it impossible.”
The letter also made me think of the importance of continuity of care. Mitch knew my mother and saw her transition from middle age to whatever you want to call the next stage. It happens over a quarter of a century. Repeated visits allowed Mitch to get to know my mom. There was time to chat. And, in addition to providing health care, he also provided caring. He cared.
He wrote the letter not because he and I developed a casual acquaintance over the years, but to say “your mother was a fiercely independent, and a strong woman. She valued her dignity. Keeping her alive in the ICU in a situation that was dire is the opposite of what she wanted. It was not who she was.” And he expressed empathy with me—relating this to deaths of his own parents and his reactions.
I fear that medicine has few opportunities for this sort of interaction now. And seeing that letter makes me feel deeply touched by the humanistic values that this extraordinary individual held dear in his practice.
I am about to have lunch with one of my closer friends—a retired professor of neurosurgery. He has always expressed strong opinions. One of them is that medical students should first be selected on the basis of their values, personalities, life experiences, and empathy. Only then should the grades and MCAT scores be revealed. His strong voice was always drowned out by those expressing the more conventional views. I believe that he is correct.