Favorite

Doctors are not unbiased; we do have favorite patients.  There are some people who make you smile when you see them on your schedule.  You try not to treat anyone differently from a medical perspective, but there are just some people you feel glad to know.

One of my favorite patients is dying right now.

She has been my patient for nearly the entire time I have practiced.  She and her husband have been regulars in my office, and it has been an absolute privilege to be their doctor.  I would do it for free.  Really.  They both grin when I walk into the room, with him usually giving a silly chuckle.  She would stand up and open her arms for a hug, which she always got.

She is in her 80\’s and is an African-American who has lived in the South for her entire life.  I never asked her what it was like, but when I asked her what she thought about a black man being a candidate for president she paused, teared up a little, and told me it was wonderful.  I can only imagine.

My nurses commented how, despite her age, she was a beautiful woman.  She carried herself with incredible class and dignity, yet was quick to laugh at my jokes (which is no small feat in and of itself).  She and her husband had worked hard to raise their family right, and whenever I talked with their children it was clear that the work paid off.  All of their kids are college-educated and are carrying on the incredible legacy of their parents.

Yesterday I got a phone call from the cardiologist who took care of her, telling me how she had gone downhill quickly and that she was now in hospice.  It was clear that he felt the same way I do about this woman and her family.  \”When the family walked on the ward, all of the hospital staff knew that they were something really special,\” he told me.  We shared with each other what incredible respect and affection we had for her and her husband.

As a doctor there is a necessary line you have to draw.  You cannot become too emotionally involved or invested in your patients; if you do, you will not last long.  There is too much suffering and death you will inevitably see for you to not set up significant boundaries in this area.  My job is not to keep my patients alive forever; it is to walk alongside of them through the physical and emotional trials they endure, making the journey as healthy and comfortable as possible.  Each year I practice I will lose a certain number of patients – some expected, some not.

This situation blurs that line.  I am very sad to be losing such a wonderful part of my life.  My heart is heavier than usual.  But even now I remain guarded.  I have to carry on with my job, see other patients, and continue being father and husband.  Still I will do what I can to make it to her funeral (I have only done that a handful of times).  I owe her that respect.

Her impact is huge.  The world is a much better place for her and her husband being here.  My life is much better.

Thank you.  It has been an incredibly honor.

If only I could get one more hug.

55 thoughts on “Favorite”

  1. She’s in hospice care but is she still A&O? Unless she’s obviously suffering (I’m sure her pride would be wounded), perhaps you could just stop by and give a visit thanking her for being her–maybe even get that hug after all.
    Heartwarming story, Dr. Rob.

  2. She’s in hospice care but is she still A&O? Unless she’s obviously suffering (I’m sure her pride would be wounded), perhaps you could just stop by and give a visit thanking her for being her–maybe even get that hug after all.
    Heartwarming story, Dr. Rob.

  3. I second Enrico’s comment, Rob. Stop by, it’ll be good for both of you.
    I love people/families like this one. What a world we would have, if everyone was like them!

  4. I second Enrico’s comment, Rob. Stop by, it’ll be good for both of you.
    I love people/families like this one. What a world we would have, if everyone was like them!

  5. I agree with the other comments. Go. Just stop in for a bit. I know I’d rather my doctor stopped one last time to see me, than making time for the funeral. Both parties would understand the visit. You would leave a smile on her face too.

  6. I agree with the other comments. Go. Just stop in for a bit. I know I’d rather my doctor stopped one last time to see me, than making time for the funeral. Both parties would understand the visit. You would leave a smile on her face too.

  7. I say amen to the others. She and her family will value your visit now much more than one at the funeral home. You are already emotionally involved. This isn’t going to change anything there. But it will change something for them. And they’ll appreciate it.
    God love you, Dr. Rob.

    Hugs…

  8. I say amen to the others. She and her family will value your visit now much more than one at the funeral home. You are already emotionally involved. This isn’t going to change anything there. But it will change something for them. And they’ll appreciate it.
    God love you, Dr. Rob.

    Hugs…

  9. The question is not whether they would appreciate it, it is whether or not I can emotionally bear crossing the line. When you hold a balance like that, it is difficult to let yourself cross that line. I am not saying it won’t be a good thing, I am just saying the emotional barrier to cross is huge.

  10. The question is not whether they would appreciate it, it is whether or not I can emotionally bear crossing the line. When you hold a balance like that, it is difficult to let yourself cross that line. I am not saying it won’t be a good thing, I am just saying the emotional barrier to cross is huge.

  11. Quite certainly you have given to her as much as you have received. Some people are really able to wipe all of the smut and dirt out of medicine and take it to where we all dreamed it would be on our first day of medical school. I’m glad you got to know her.

  12. Quite certainly you have given to her as much as you have received. Some people are really able to wipe all of the smut and dirt out of medicine and take it to where we all dreamed it would be on our first day of medical school. I’m glad you got to know her.

  13. “The question is not whether they would appreciate it, it is whether or not I can emotionally bear crossing the line. When you hold a balance like that, it is difficult to let yourself cross that line. I am not saying it won’t be a good thing, I am just saying the emotional barrier to cross is huge.”
    Yessir, that’s true. But doctors aren’t the only ones who deal with that line. Not if they work with people, anyhow. It’s not a hard, fast line. It’s a curvy gray one, and sometimes it gets erased. All pain is not bad pain. And I suspect they’ll be celebrating her life more than mourning her death. You can celebrate, too.

    “Tuesdays with Morrie” comes to mind.

  14. “The question is not whether they would appreciate it, it is whether or not I can emotionally bear crossing the line. When you hold a balance like that, it is difficult to let yourself cross that line. I am not saying it won’t be a good thing, I am just saying the emotional barrier to cross is huge.”
    Yessir, that’s true. But doctors aren’t the only ones who deal with that line. Not if they work with people, anyhow. It’s not a hard, fast line. It’s a curvy gray one, and sometimes it gets erased. All pain is not bad pain. And I suspect they’ll be celebrating her life more than mourning her death. You can celebrate, too.

    “Tuesdays with Morrie” comes to mind.

  15. I think we all have our “favorite” patients. Practicing in a relatively small area, I have patients make me quilts, bring me food, etc. all because you become close to these people. I would echo the other comments about going to visit while she is in Hospice in addition to attending the funeral if possible. Although we have to remain objective, physicians are human as well. It is that humanity that makes us who we are. It will do the patient good to see you and the family will never be the same if her doctor takes the time to come by. I hope it all goes well….

  16. I think we all have our “favorite” patients. Practicing in a relatively small area, I have patients make me quilts, bring me food, etc. all because you become close to these people. I would echo the other comments about going to visit while she is in Hospice in addition to attending the funeral if possible. Although we have to remain objective, physicians are human as well. It is that humanity that makes us who we are. It will do the patient good to see you and the family will never be the same if her doctor takes the time to come by. I hope it all goes well….

  17. Oh Dr Rob…I am sorry you are losing your dear patient. <<>>
    No doubt you were all privileged to know each other. Relationships like that are a gift and you learn, give and receive from each other.

    This is one of the sweetest, most beautiful posts I have ever read in the med blogosphere…no doubt from the heart of a compassionate and appreciative doctor.

    I also agree with the others and think you should cross that “curvy gray” line. You’ve already crossed it and you just might get that last hug. A visit from you…the doctor who has been with them through thick and thin…it will mean the world to them. It might be a good closure for you too.

    You said “My job is not to keep my patients alive forever; it is to walk alongside of them through the physical and emotional trials they endure, making the journey as healthy and comfortable as possible.” I think that is beautiful. Also a healthy perspective to have while treating your patients.

    Just to let you and the other doctors know…some of us patients feel the same way about the good doctors in our lives. Personally…if I could … I would do anything to bring blessing into the lives of a couple of special docs I have. And if anything happened to them…I would be devastated.

    Speaking as a patient…I would be honored to think that a doctor cared about me as you do for this woman.

    I also think you should take some of what you have written and handwrite it in a card for them. They can go back to it again and again if they want to. I would treasure this post if one of my doctors had written it about me or someone I loved.

    I am linking to this because I think it is inspirational.

  18. Oh Dr Rob…I am sorry you are losing your dear patient. <<>>
    No doubt you were all privileged to know each other. Relationships like that are a gift and you learn, give and receive from each other.

    This is one of the sweetest, most beautiful posts I have ever read in the med blogosphere…no doubt from the heart of a compassionate and appreciative doctor.

    I also agree with the others and think you should cross that “curvy gray” line. You’ve already crossed it and you just might get that last hug. A visit from you…the doctor who has been with them through thick and thin…it will mean the world to them. It might be a good closure for you too.

    You said “My job is not to keep my patients alive forever; it is to walk alongside of them through the physical and emotional trials they endure, making the journey as healthy and comfortable as possible.” I think that is beautiful. Also a healthy perspective to have while treating your patients.

    Just to let you and the other doctors know…some of us patients feel the same way about the good doctors in our lives. Personally…if I could … I would do anything to bring blessing into the lives of a couple of special docs I have. And if anything happened to them…I would be devastated.

    Speaking as a patient…I would be honored to think that a doctor cared about me as you do for this woman.

    I also think you should take some of what you have written and handwrite it in a card for them. They can go back to it again and again if they want to. I would treasure this post if one of my doctors had written it about me or someone I loved.

    I am linking to this because I think it is inspirational.

  19. Rob, I cannot tell you how much it meant to me and my sisters that dad’s primary care physician (who had pretty much handed dad over to the oncologists a couple of months before) took time to come to the house when dad was slipping out the door, for a short visit.
    My prescription? (And I think I’m at least 10 years older than you, so old enough to give you directions): go to the hospice, hold her hand, and say to her what you’ve said to the world, here on your blog.

    At the very least: go to hospice, hold her hand, and tell her “It’s been an honor to know you. Thanks for what you’ve brought to my life.”

    Death is a part of life, and honoring the passing is what makes us human.

    The day before my dad died, I sat on the neighbor’s porch, bawling and pleading for Just One More Day with my dad as he was before the metastatic stuff got to his brain. Then the cool wind blew, and I got the message: One More Day would never have been enough. We had what we had.

    And that gave me the peace, or the brain-space, to be fully present with my dad’s last day.

    I guess I’d say, if you don’t visit Mrs. Patient, you are short-changing yourself.

  20. Rob, I cannot tell you how much it meant to me and my sisters that dad’s primary care physician (who had pretty much handed dad over to the oncologists a couple of months before) took time to come to the house when dad was slipping out the door, for a short visit.
    My prescription? (And I think I’m at least 10 years older than you, so old enough to give you directions): go to the hospice, hold her hand, and say to her what you’ve said to the world, here on your blog.

    At the very least: go to hospice, hold her hand, and tell her “It’s been an honor to know you. Thanks for what you’ve brought to my life.”

    Death is a part of life, and honoring the passing is what makes us human.

    The day before my dad died, I sat on the neighbor’s porch, bawling and pleading for Just One More Day with my dad as he was before the metastatic stuff got to his brain. Then the cool wind blew, and I got the message: One More Day would never have been enough. We had what we had.

    And that gave me the peace, or the brain-space, to be fully present with my dad’s last day.

    I guess I’d say, if you don’t visit Mrs. Patient, you are short-changing yourself.

  21. A beautiful post.I agree, cross the emotional line. You both deserve that.
    Speaking from a client perspective. I think we know that line is there too and when doctor’s cross it, it’s something.
    From a nursing perspective. Sometimes you just need to make that leap from professional to friend. Sometimes it’s the right thing for both parties and although it will hurt and might blur the line for a little while, you will be thankful you did, in the long run.

    It’s a hard place to be.

    Thank you for this heartfelt post, though. I appreciate your honesty.

  22. A beautiful post.I agree, cross the emotional line. You both deserve that.
    Speaking from a client perspective. I think we know that line is there too and when doctor’s cross it, it’s something.
    From a nursing perspective. Sometimes you just need to make that leap from professional to friend. Sometimes it’s the right thing for both parties and although it will hurt and might blur the line for a little while, you will be thankful you did, in the long run.

    It’s a hard place to be.

    Thank you for this heartfelt post, though. I appreciate your honesty.

  23. This brought tears to my eyes. You are a beautiful person. Your patients too. I am so sorry to hear this news. How awful to have to go through this. I cannot imagine. I really feel for your situation.
    Your good heart and professionalism reminds me of my neurosurgeon. I don’t know how you feeling doctors do it, really. But I am glad that you exist.

    Thank you for sharing this as we sometimes can take for granted the beautiful people in our lives.

  24. This brought tears to my eyes. You are a beautiful person. Your patients too. I am so sorry to hear this news. How awful to have to go through this. I cannot imagine. I really feel for your situation.
    Your good heart and professionalism reminds me of my neurosurgeon. I don’t know how you feeling doctors do it, really. But I am glad that you exist.

    Thank you for sharing this as we sometimes can take for granted the beautiful people in our lives.

  25. Gosh, this made me cry. I’d suck at being a doctor…or a nurse. Thanks for sharing.

  26. Gosh, this made me cry. I’d suck at being a doctor…or a nurse. Thanks for sharing.

  27. it’s hard, we need to protect ourselves.
    my take on the situation is, in 10 years which would you regret more, a) not visiting or b) visiting?

    good luck

  28. it’s hard, we need to protect ourselves.
    my take on the situation is, in 10 years which would you regret more, a) not visiting or b) visiting?

    good luck

  29. Dr. Rob, I just found you from the NYTimes story. Thank you for sharing this. I’ve somehow managed to forget that there are doctors who like their work or have long-term relationships with patients — as a young, healthy person in a big city, I don’t see doctors like that. Here in DC, the focus is on convincing the world how bad doctors have it, to make the case for obscure policy changes.
    Thank you for being a human, caring, sharing person and a physician. And best wishes for you and this favorite patient.

  30. Dr. Rob, I just found you from the NYTimes story. Thank you for sharing this. I’ve somehow managed to forget that there are doctors who like their work or have long-term relationships with patients — as a young, healthy person in a big city, I don’t see doctors like that. Here in DC, the focus is on convincing the world how bad doctors have it, to make the case for obscure policy changes.
    Thank you for being a human, caring, sharing person and a physician. And best wishes for you and this favorite patient.

  31. Dear Dr. Rob – I also just found you and this story in the NYTimes today. I’m sitting here bawling. I wish someone like you came to my parents’ deathbeds. I agree with the other posters – go see your patient in hospice. She and her family will be so grateful and touched. Bless you.

  32. Dear Dr. Rob – I also just found you and this story in the NYTimes today. I’m sitting here bawling. I wish someone like you came to my parents’ deathbeds. I agree with the other posters – go see your patient in hospice. She and her family will be so grateful and touched. Bless you.

  33. Another NY Times reader. Love your blog. Touching story. I do not stand in your shoes, but my vote is to go see her. I’m so glad I read your llama post after this one!

  34. Another NY Times reader. Love your blog. Touching story. I do not stand in your shoes, but my vote is to go see her. I’m so glad I read your llama post after this one!

  35. “Get a hug”?? I suggest you visit her and give one back! Lately, I’ve started to struggle with worry for some of my patients that I’ve really come to know quite well over the past eight years and as time marches on, I know I’m going to need to attend wakes and funerals in the near future, of the ones that I really like/love. While there are many trials and tribulations in some doctor/patient relationships, there are some people who you just really love and respect, like your patient. If you haven’t seen her and given her a hug yet, if she’s still here, I suggest you do so! It will help the both of you.
    Paul

  36. “Get a hug”?? I suggest you visit her and give one back! Lately, I’ve started to struggle with worry for some of my patients that I’ve really come to know quite well over the past eight years and as time marches on, I know I’m going to need to attend wakes and funerals in the near future, of the ones that I really like/love. While there are many trials and tribulations in some doctor/patient relationships, there are some people who you just really love and respect, like your patient. If you haven’t seen her and given her a hug yet, if she’s still here, I suggest you do so! It will help the both of you.
    Paul

  37. Oh Dr. Rob, I just recently found your blog, and I spent hours reading your past posts. I think your’e a great man, and I think that’s what makes you a great Doctor This post made me tear up. I worked in a hospital for years, and the part of the blog that spoke about not getting emotionally involved with your patients, or you wouldn’t last long touched me deeply, because that’s when I knew this was one patient who made it past your boundaries. Your words made me remember the patients who made their way around mine. You should do what makes you feel right. That will be the right thing to do with this patient.

  38. Oh Dr. Rob, I just recently found your blog, and I spent hours reading your past posts. I think your’e a great man, and I think that’s what makes you a great Doctor This post made me tear up. I worked in a hospital for years, and the part of the blog that spoke about not getting emotionally involved with your patients, or you wouldn’t last long touched me deeply, because that’s when I knew this was one patient who made it past your boundaries. Your words made me remember the patients who made their way around mine. You should do what makes you feel right. That will be the right thing to do with this patient.

  39. I found you through a sequence of links ending at NYT. My thought is that anyone can make friends at work, and they don’t have to be co-workers. The friendship doesn’t have to involve family barbecues and vacations together it can be just a simple humane love. I have no doubt, a visit from you would be a tonic to all parties. It would help you as well as them.

  40. I found you through a sequence of links ending at NYT. My thought is that anyone can make friends at work, and they don’t have to be co-workers. The friendship doesn’t have to involve family barbecues and vacations together it can be just a simple humane love. I have no doubt, a visit from you would be a tonic to all parties. It would help you as well as them.

  41. I think you can get that last hug. My Mom’s doctor stopped by our house a week before my Mom went into hospital and she always hugged him too. That day she didn’t have the strength to stand up to hug him so he bent down to her. I don’t think he realized, or maybe he did, that it would be the last time he would see her…ciao

  42. I think you can get that last hug. My Mom’s doctor stopped by our house a week before my Mom went into hospital and she always hugged him too. That day she didn’t have the strength to stand up to hug him so he bent down to her. I don’t think he realized, or maybe he did, that it would be the last time he would see her…ciao

  43. Dr. Rob:Patients have favorite doctors too!
    I have a congenital heart defect and my cardiologist has been with me over 22 years. Every time I see him I want to squeeze him! He is just…a great person and a great doctor. But the relationship is so interesting because of its unique intimacy.
    Anyway, I bet your patient feels the same way about you.

  44. Dr. Rob:Patients have favorite doctors too!
    I have a congenital heart defect and my cardiologist has been with me over 22 years. Every time I see him I want to squeeze him! He is just…a great person and a great doctor. But the relationship is so interesting because of its unique intimacy.
    Anyway, I bet your patient feels the same way about you.

  45. While I understand (and share) the posters’ encouragement that you visit your patient for one last hug, I also understand, to some small degree, your need to set boundaries and guard your emotions. Doctors must deal with a lot of pain and death in inevitable..
    I have a friend who is a pulmonologist. He sometimes takes the death of a patient very personally, especially when the patient is young. He becomes testy and withdraws. He suffers and his family suffers.

    While we all want our doctors to provide compassionate care, I also want my doctor to have a healthy emotional and family life when he is away from the office or hospital. You, and they, deserve it.

    Whatever you decide to do about visiting (or not visiting) the patient will be the right decision.

    God bless you.

  46. While I understand (and share) the posters’ encouragement that you visit your patient for one last hug, I also understand, to some small degree, your need to set boundaries and guard your emotions. Doctors must deal with a lot of pain and death in inevitable..
    I have a friend who is a pulmonologist. He sometimes takes the death of a patient very personally, especially when the patient is young. He becomes testy and withdraws. He suffers and his family suffers.

    While we all want our doctors to provide compassionate care, I also want my doctor to have a healthy emotional and family life when he is away from the office or hospital. You, and they, deserve it.

    Whatever you decide to do about visiting (or not visiting) the patient will be the right decision.

    God bless you.

  47. I remember the friends and acquaintances that came to my parents’ funerals, but I thank goodness for those few that visited my mother and my father in their last years.

  48. I remember the friends and acquaintances that came to my parents’ funerals, but I thank goodness for those few that visited my mother and my father in their last years.

  49. Dear Dr. Rob:
    Thank you so much for your article. Although this is going to you long after the funeral, here’s hoping that all went well for you.

    I agree with Emily: “Patients have favorite doctors too.” I fail to understand why there is so much emphasis on the doctor-patient relationship when, without warning, the doctor can just up and leave town and transfer your care to the other doctors in a practice. It has been devastating for me to find out after-the-fact that my doctor has left town without notice. It makes the whole relationship thing feel self-serving for the doctor, like “Now that I’m leaving, there’s no need to communicate anything to you.”

    I grew up in the days when my parents were warm and chummy with our doctors with cards and presents. My sister and I were adopted, and though we moved a hundred miles away, the doctor that delivered us actually wrote long, lengthy letters to my sister and I each Christmas, to which we would respond. This seemed ordinary at the time. If only I had seen it for the pearl of great price that it was, I would have treasured it more. When my sister was getting married, that doctor even forwarded a letter my sister’s birth mother had written him when my sister was about three. He had kept it for about 23 years! I sure miss Dr. Andrews, and I wish things were warmer with our doctors today, but they seem like they want to keep things distant.

  50. Dear Dr. Rob:
    Thank you so much for your article. Although this is going to you long after the funeral, here’s hoping that all went well for you.

    I agree with Emily: “Patients have favorite doctors too.” I fail to understand why there is so much emphasis on the doctor-patient relationship when, without warning, the doctor can just up and leave town and transfer your care to the other doctors in a practice. It has been devastating for me to find out after-the-fact that my doctor has left town without notice. It makes the whole relationship thing feel self-serving for the doctor, like “Now that I’m leaving, there’s no need to communicate anything to you.”

    I grew up in the days when my parents were warm and chummy with our doctors with cards and presents. My sister and I were adopted, and though we moved a hundred miles away, the doctor that delivered us actually wrote long, lengthy letters to my sister and I each Christmas, to which we would respond. This seemed ordinary at the time. If only I had seen it for the pearl of great price that it was, I would have treasured it more. When my sister was getting married, that doctor even forwarded a letter my sister’s birth mother had written him when my sister was about three. He had kept it for about 23 years! I sure miss Dr. Andrews, and I wish things were warmer with our doctors today, but they seem like they want to keep things distant.

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