Blog | Monday, June 25, 2012

Remembering a warm-hearted patient


When I was a resident I worked in a general medicine clinic. One afternoon each week, I'd get more dressed than usual and split off from my inpatient team around noon to go see patients in another building, outside of the hospital.

Today, I'm reminded of a man I saw there and treated for two years. His name was Mr. Sunshine. (The patient's name was not Mr. Sunshine, but it was equally evocative of his disposition.) The first time I met him, it was in the midst of a noisy, crowded and windowless waiting room.

"Mr. Sunshine?" I called out, as loudly as I could from the receptionists' desk. I'd skimmed through his chart including partial notes of a recent hospitalization. It was 1988, long before we stopped calling patients by their names in public areas. He stood up and greeted me with a broad smile. He shook my hand before I guided him to a smaller, quieter windowless room for his examination. He carried a medium-sized suitcase.

Mr. Sunshine had heart disease, kidney disease, diabetes, and peripheral vascular disease. He'd had a heart attack or two, and possibly a stroke. He was a large man. As I recall, he came from North Carolina but had lived most of his life in Brooklyn. After some brief, standard but sincere chit-chat about who we each were, I asked him why he was there in the clinic. "I'm sick," he said. "I think maybe I should be in the hospital." That was, essentially, his chief complaint.

Being the diligent resident that I was, I attempted to get through a review of systems, the drill by which doctors run through a lot of questions as fast as possible, starting like this: "Do you get headaches, earaches, have trouble hearing, double vision, blurred vision, sinus congestion, a runny nose, frequent sore throats, swollen glands, cough, pain on swallowing ..."

Keep in mind, this was before most doctors had sheets for patients to answer these questions in advance, on a checklist, or nurse practitioners to ask the questions for them. If you were lucky, and smooth, and the patient wasn't "difficult" or really sick, you could get through a complete review of systems in less than 1.5 minutes.

Mr. Sunshine said he was tired and short of breath most of the time. He pulled from his suitcase a crumpled, large brown bag with more than 20 medication vials and vitamins. There was a set of pajamas inside, and other stuff including a toothbrush.

I didn't admit Mr. Sunshine to the hospital that day, but we bonded. He stayed as my patient in the clinic for two years, always treating me with respect while I adjusted and tried to reduce his meds.

Once he asked me if he might ask me a question.

"Sure," I told him.

"Are you Jewish?" he asked.

"Yes, I am."

He nodded. I lacked the nerve to ask him why he wanted to know. He told me he sang at his church.

When I moved on to become a fellow in hematology and oncology, Mr. Sunshine asked if he could still be my patient. I told him that in my new position I'd be working in another clinic, and only with patients who had either cancer or serious blood disease. He didn't have cancer, or sickle cell anemia, or anything like that.

"If I get leukemia, will you be my doctor?" he asked me.

"Yes," I told him. "But it's a good thing you don't have that now," I said, adding: "I wish you the best, Mr. Sunshine."

I've been thinking lately, what makes you recall some patients. I hope he's doing OK, wherever he is now. Same for all my patients, really. I wish I could tell them.

This post originally appeared at Medical Lessons, written by Elaine Schattner, ACP Member, a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.