Donna dropped her blood-thinner tablets on the floor prior to surgery.
“It’s a sign I shouldn’t be taking them,” she said.
Now, sometime later, it makes me smile to think of it; she’s recovered well from the surgery and has resumed her medications. I’d told her to stop taking them just prior to the surgery—a complex hernia repair—and to resume them the day after, but she’s the type of person who does what she wants, what she thinks is best.
As her doctor, I felt worried about her stopping the anticoagulant, of course, and I asked her to speak to her cardiologist about it; but as a person, I enjoyed and respected her strong, feisty personality.
At her first follow-up visit after the procedure, she brought along a family member. I removed her drain and staples, then had her schedule a routine follow-up for a few months later. The dynamic is always different when someone else is present. Sometimes it’s better; sometimes it’s more challenging—but it’s always different, depending on who’s in the room. This follow-up visit, anyway, was more focused on the tasks at hand for the immediate future.
During her next and final visit, Donna was doing well, and our interaction was more of a social visit, as it can be with longer-term patients. You’ve known them for a while, they’re happy with their outcome, and there isn’t much medicine to discuss.
“God bless you,” she said. “Thank you so much for everything.”
Tears almost sprang into my eyes at her words. I felt overwhelmed and taken aback by her gratefulness. Until now, I hadn’t realized just how miserable her hernia had made her.
“I didn’t feel like a woman,” she confided. “I couldn’t eat properly. I was so embarrassed to go outside.” She couldn’t stop thanking me.
Even a year or so ago, I would have felt embarrassed by what I viewed as flattery. “I’m just doing my job,” I might have said. “Of course I’m happy to help; it’s not a big deal.”
Now, though, I realize that “Thank you” is something that patients want and need to say. Over time, I’ve gradually come to see that my patients’ “Thank you” is just as much a statement of the connection they feel as it is an expression of gratitude for the care they’ve received. Feeling embarrassed or saying “It’s nothing” isn’t the right response, as it downplays that connection. And their thankfulness makes me feel grateful in turn that I’m able to do this work.
Nowadays I smile, say “Thank you” back and let us both feel connected by the words of gratefulness. It helps me feel that I made a difference; and after all, making someone’s life better is the reason I do what I do.
“God bless you,” Donna said. “Can I have a hug?”
Of course she could. In my experience, most patients don’t ask; they just hug. That’s fine, too, but this felt even more meaningful—the first time a patient had asked my permission.
Donna is a petite older lady. I’m short myself, but I felt tall next to her. Her stature is deceptive; she may be small, but she’s mentally strong, resilient, bold. The hug was meaningful for me, too; it felt good to know that this person I’ve helped now has a better life.
Then we moved on to some other business. I told her that she could do any activity she wanted, and half-guiltily, half-unabashedly she confessed, “I have been doing whatever I want. My aide comes in to help, but there are certain things she’s not allowed to do. She tells me not to do them, but I do them anyway. My son doesn’t know how to do them. I like being independent.”
“I know. I can see it,” I told her, thinking, Anyway, someone has to do these things, if her aide and her son can’t; if she can do them, why not?
“You’ve helped me so much,” she said.
“I was happy to help,” I told her. “The greatest reward is that you’re happy after surgery.”
“No one else listened,” she responded. “They didn’t want to do the surgery. No one else wanted to help. And then I found a little lady.”
I chuckled.
“One little lady helping another little lady,” I said, thinking, But neither of us are little in spirit.
The RVUs (Relative Value Units, used to measure a physician’s productivity) that were assigned to the case don’t capture any of its essence, our interpersonal dynamic. Nor do my notes in the medical record.
“Doing well, follow up as needed,” I wrote. This remark doesn’t convey my patient’s gratefulness. It doesn’t express the lightness I feel.
It doesn’t capture her heart—or mine.
6 thoughts on “From One Little Lady to Another”
Gratitude multiplies for all of us! thank you for your story.
Loved this story. Thank you for sharing it, and for being the physician and person you are.
Thank you for the RVU image. A system designed by people unable to see square pegs and round holes.
Glad to feel your joy
This is such a joyous and heartening account. It’s the old E M Forster “Only connect” once again, and a vivid instance thatthe humane side of our profession clings to life despite massive barriers about money, time, and focus—which you acknowledge with a very gracious and light touch.
Two weeks ago, Fast Facts (my other favorite online medical periodical) discussed saying goodbye to a dying patient, and included the same wise counsel that you articulate here, namely to embrace the gratitude and not demean it with “I was only doing my job”. No ONLY about it. And as the others said, Yes, please keep writing
What a wonderful story exploring the real connection between you and your lovely patient. I was particularly touched by your realization that you and your patient both grew and benefited from her thank you to you and that it’s not something to be brushed aside. Please do keep writing-we can all benefit from your thoughtful perspective!
Beautiful story. Thank you!