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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.