Mourning My Patient, Mr Schwartz

Ruth Kannai; Aya Rice Alon

doi:10.1370/afm.2710

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RE: thank you.
Benjamin TB Brown

Published on: 26 September 2021
RE: Ruth Kannai and Mr. Schwartz
Aya Biderman

Published on: 22 September 2021
RE: thank you Ruth
Shmuel Pinchas Reis

Published on: 18 September 2021

Published on: (26 September 2021)
Page navigation anchor for RE: thank you.
RE: thank you.
Benjamin TB Brown, Physician, Blue Ridge Medical Center
This a very well written article about a very important, and touching story. This story is close to what I experienced multiple times as a rural family physician.
The connections with our patients make our lives and practice richer, and worthwhile, in a profession that is becoming more difficult to practice in a humane fashion.
Thank you for bringing back these memories to me.

Competing Interests: None declared.
Published on: (22 September 2021)
Page navigation anchor for RE: Ruth Kannai and Mr. Schwartz
RE: Ruth Kannai and Mr. Schwartz
Aya Biderman, Family physician, Clalit Health care services, and Ben-Gurion University, Beer Sheva, Israel
Dr Kannai brings us another story from her family medicine work in a small town, where she has practiced for many years. The story of Mr. Schwartz. Not all patients become so special for us, almost part of our life, part of our families. It seems that Mr. Schwartz was this kind of "very special patient" for Dr Kannai. Their emotional bonds were so close, and their mutual feelings had a long history.
These special patients stay with us, even many years after their death. I sometimes meet "my patients" in the graveyard, still vividly remembering them and feeling sad.
Interestingly, our emotions as family physicians, whether positive or negative, are not frequently expressed in the medical literature. Perhaps these issues are not so interesting?! Or, maybe, expressing your feelings as a physician, seems to be non-professional?
One possible way to express emotions is in Balint groups, which are also helpful in circumstances where our emotions overwhelm us and “get in our way”. By presenting such “cases”, where our emotional reactions cause us unpleasant feelings or even disturb our life, we can get great help from our colleagues.
Dr Kannai has another way of dealing with such difficulties, by writing stories. Her stories are so moving. Family physicians can connect to them, having similar experiences of their own. Many readers, who are not family physicians, might wonder about the depth of emotional bonds between physicians and patie...
Show More

Dr Kannai brings us another story from her family medicine work in a small town, where she has practiced for many years. The story of Mr. Schwartz. Not all patients become so special for us, almost part of our life, part of our families. It seems that Mr. Schwartz was this kind of "very special patient" for Dr Kannai. Their emotional bonds were so close, and their mutual feelings had a long history.
These special patients stay with us, even many years after their death. I sometimes meet "my patients" in the graveyard, still vividly remembering them and feeling sad.
Interestingly, our emotions as family physicians, whether positive or negative, are not frequently expressed in the medical literature. Perhaps these issues are not so interesting?! Or, maybe, expressing your feelings as a physician, seems to be non-professional?
One possible way to express emotions is in Balint groups, which are also helpful in circumstances where our emotions overwhelm us and “get in our way”. By presenting such “cases”, where our emotional reactions cause us unpleasant feelings or even disturb our life, we can get great help from our colleagues.
Dr Kannai has another way of dealing with such difficulties, by writing stories. Her stories are so moving. Family physicians can connect to them, having similar experiences of their own. Many readers, who are not family physicians, might wonder about the depth of emotional bonds between physicians and patients. They are genuine and real!
I think that this is the true marvel of being a family physician in a community.
Show Less

Competing Interests: None declared.
Published on: (18 September 2021)
Page navigation anchor for RE: thank you Ruth
RE: thank you Ruth
Shmuel Pinchas Reis, Family Physician, Hebrew University Faculty of Medicine
Thank you Ruth, for sharing this most moving narrative of your care and the relationship with Mr. Schwartz. We family docs have this happening to us regularly. A patient we care for takes us to their heart and we reciprocate. We become friends, share intimate moments and existential concerns. When we share compelling personal history (Holocaust) and they remind us of our own loved ones, the plot thickens (and boundaries challenged). Once life threatening conditions step in, there is no escape from addressing end-of-life needs. The elderly (or not), eventually dying patient meets the wounded healer.

The loneliness of the family physician in these circumstances may become oppressing, and yours, Dr. Kannai is no exception. You mention a nurse, but she doesn’t seem to alleviate your need to share. Teaching and being self-disclosing is one venue for channeling the natural need for companionship and processing. Writing it is yet another.

Conflicts are inevitable, i.e. accepting his continued smoking, relations with Mr. Schwartz son and daughter in law, his request that cannot be fulfilled for assistance in dying (especially when even if it was legal the physician’s conscience is prohibiting her from contemplating it. Should she consider referral?)

While many issues are evoked by your narrative, and delving into them risk taking away from the lived experience you so touchingly share, perhaps just mentioning them may avoid this risk. Confrontations (see confli...
Show More

Thank you Ruth, for sharing this most moving narrative of your care and the relationship with Mr. Schwartz. We family docs have this happening to us regularly. A patient we care for takes us to their heart and we reciprocate. We become friends, share intimate moments and existential concerns. When we share compelling personal history (Holocaust) and they remind us of our own loved ones, the plot thickens (and boundaries challenged). Once life threatening conditions step in, there is no escape from addressing end-of-life needs. The elderly (or not), eventually dying patient meets the wounded healer.

The loneliness of the family physician in these circumstances may become oppressing, and yours, Dr. Kannai is no exception. You mention a nurse, but she doesn’t seem to alleviate your need to share. Teaching and being self-disclosing is one venue for channeling the natural need for companionship and processing. Writing it is yet another.

Conflicts are inevitable, i.e. accepting his continued smoking, relations with Mr. Schwartz son and daughter in law, his request that cannot be fulfilled for assistance in dying (especially when even if it was legal the physician’s conscience is prohibiting her from contemplating it. Should she consider referral?)

While many issues are evoked by your narrative, and delving into them risk taking away from the lived experience you so touchingly share, perhaps just mentioning them may avoid this risk. Confrontations (see conflicts above), relational rituals, advance directives (mentioning his DNR request in the EMR may not be helpful when his son takes him to the ER, or an emergency service is called to his home after hours), the place of legal terminal sedation when suffering is not exclusively physical and more. Also the clinician’s well-being, isolation, venues for processing grief, failure, helplessness, also the joy of family doctoring.

Here, narrating, comes to our rescue, you write it down and you send it for publication. The channels for further self-reflection, abandoning isolation and opening oneself to the processing that the ensuing conversation provides is a blessing. Growing up and developing as people and professionals continues, and we come back to our next Mr. Schwartz better prepared. I may even be better prepared for my own woundedness as well as my finality that lurks around the corner.
Show Less

Competing Interests: None declared.