“. . . for the secret of the care of the patient is in caring for the patient.”
— FWP
Dear Doctor,
I am a consultant physician and diagnostician, living and working overseas. My father is on your list of patients to see tomorrow. I am writing to prepare you and to ask your tolerance of him. Of all the unpleasant patients you least hope to see, he will be your most difficult. The encounter will require your utmost composure.
He will be easy to recognize: obese, unshaven, unbathed, clothed in a track suit, and wearing house slippers on swollen feet. He uses a walker, because of osteoarthritis and his weight. He will probably argue with your office staff about some trivial point that he will view as a matter of principle. He will then complain to you bitterly about poor customer service, no matter how competent your staff might be.
In the examination room, he will give you ample reason not to allot him extra time or thought. The odds are that he will not like you. He is the stark opposite of the polite, deferential old lady who answers “Yes, sir” or “No, ma'am.” He will think that you are, at best, mediocre, for no good reason. My father will test your deepest resolve to practice medicine compassionately.
He started well in life. Yes, the unkempt, sour-smelling, obese old man in front of you was once the brightest light that any community might offer. He was a successful businessman, the president of the Chamber of Commerce, the county chairman of the dominant political party, a scoutmaster, and a church dean, all before the age of 30 years. He was poised to achieve great things. However, something happened along the way. He made a series of bad choices, lost jobs, and soothed his insults with fast food, booze, and porn.
I used to attend Alcoholics Anonymous meetings with him. He was once proud of his sobriety. However, his entrenched denial separated him from his support group and he resumed drinking, with misjudged moderation. Too many instances of “just this once” lubricated the slope of his decline.
He failed to consider long-term consequences. Each “just-this-once” lecherous glance cultivated his moist, bulging eyes and left fallow the discretion and strength of will that comes through practicing restraint. Each drink for relaxation after a challenging day not only led to his chronic disease—it kept him from recognizing minor challenges as trifling, or imperfect relationships as superior to principle.
Now, after living alone for 40 years, he so rarely seeks human company that he forgets both courtesy and personal hygiene. He is content to live out his days ensconced in a recliner in a government-subsidized hovel, the television turned up loudly to overcome his hearing loss, a pistol on the table. He associates only with the occasional stray dog that he befriends by offering leftover Kentucky Fried Chicken. Regardless, he is pitifully lonely, and seeing you will stir within him fundamental human emotions. Perhaps you will see through the disreputable rind of what he has become and glimpse what he once was: a patient father, an accommodating friend, a generous community member.
His early lessons have improved me as a physician. When I was a teenager, he taught me how to listen carefully to the wind and to the rain on a tin roof, as well as to walk quietly in the woods. “Shh,” he would softly say, as he absorbed everything with his ears and eyes. Learning to be so attuned has enabled me to be a better diagnostician today. He taught me honesty, which he insisted on giving and receiving. His example has helped me during candid conversations when a patient's prognosis is grim.
He has, without knowing, increased my compassion toward the glutton, the addict, and the drunk, and especially the angry and intolerant who are difficult to abide. Despite his having been all of those, my father taught me to do what I now ask of you: to accept his imperfections.
As an outgrowth of his life and examples, I have promised myself to be a better doctor: to listen more carefully, speak more gently, and act more kindly—even to patients who appear to be rude or self-destructive, or seem to feel entitled. I will not leave their bedsides without expressing sympathy. When I meet a patient like my father who cynically mistakes compassion for insincerity, and who is hobbled by an honesty not yoked with good judgment, I offer my compassion and tolerance regardless.
I have realized that physicians must be rocks of fidelity, giving the same loyalty to difficult patients that my father gives to stray dogs. Our hands should be continuously outstretched, despite a patient's bad choices and the risk that our hand will be bitten.
As long as my father is alive, I have hope for his renewal. Please recognize who he once was, and remind him that he is still valuable. Thank you in advance for your compassionate consideration of my request.
From the heart,
A Loving Son
