Grace, Ray and Medicine

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 In 1959 I inherited some elderly patients from  Ray, my senior partner. Since 1930 he had been an old style General Practitioner, a G P,  in our Northern California  rural town of 15,000; house calls were still a  time honored part of his practice-at first $1.50 rural, $1.00 in -town; and still only $5 and $7.50. –  payable in produce, or services, or interest-free in bits and promises. Ray earnestly  introduced me to his  cherished old timers,  fragile  living shards of history  found in termite infested stately old farm houses, and small decaying town homes .
Some visits required specific treatments  like parenteral diuretics; others consisted  only of  dubiously therapeutic but innocuous vitamin shots-  perhaps  given IV when the complaint seemed acute but  technically inconsequential.   Unhurried banter, encouragement,  and gossip were routine for Ray’s  home visits. We always visited on Wednesday afternoon and  early evening  because predictability was a vital aspect of the ‘care’ provided;  to fail would cause much distress.
I continued  to visit Ray’s home patients until only Grace remained.  Her  thick chart held many pages of  cryptic  or barely legible hand written entries, interspersed with print records of formal exams, hospitalizations, consultations, lab and X-ray reports. She was born in Weaverville, CA, in 1888, had a family history of heart attack (father and brother), diabetes (mother). Her son and husband were mining engineers which required constant moves;  they had lived in  mining towns of  Canada, Philippines, Mexico, Chile, Peru,  and   Australia, as well as several times each in Nevada, Washington, and Arizona.
Her personal health history included: Rheumatic Fever  age 8- one  yr bed rest- residual mitral valve disease and  very mild chronic heart failure . Life long smoking, stopped 4 years ago due to recurring bronchial infections and Dengue  Fever age 30 with loss of hair but  recovery, no known residual; Hysterectomy (bleeding myomata); Cholecystectomy (gall bladder) ; Thyroidectomy for  benign goiter. There was a history of several brief hospitalizations for   ‘bronchopneumonia’,  6 years prior Grace had a fall with pelvic fracture felt due to syncope-fainting-  from an episode of abnormal heart rate and rhythm- no further episode on medication. Grace held California Teacher’s certificate in English. She taught in several countries  at times when no school for  English speakers was  available, using a  six grade British  Correspondence  college prep course (The Calvert System).  She was a free lance writer of essays and travelogues published mainly by The  Atlantic, Look, Life, and others.  She played the violin until a few years ago and still played her old upright piano regularly.
 Grace had two  grown Children, a clutch of grand children-one son an engineer and a daughter a teacher- all  living  in Australia. In the second year I knew Grace she broke her hip. After surgery  and a long hospital stay ( common in those days)  she was sent to a nursing home to complete her recovery.  Immediately thereafter she became very withdrawn,  and refused to eat; she  rapidly deteriorated mentally, was confused and agitated especially at night, obviously was depressed. Although I spoke  frankly with her children, her  friends, and her minister, (HA! No HIPPA  law then; that would be more difficult today because of a superior law: that of unintended consequences- or better said- collateral damage.) Her children called regularly and friends visited frequently. Yet her condition continued to deteriorate. Discussion and reason seemed to have no effect, nor did the medications available then.  She began to soil herself.
Then her roommate, a terminally ill diabetic, suddenly died and was replaced by a woman with chronic kidney failure.  Within two days, Grace began to improve in every respect. She ate well, took her medications readily, walked with her walker eagerly, and was conversant.  I had to ask: Why? What happened? But her answer was hesitant and slightly evasive. I persisted until finally she smiled broadly and said: “My neighbor.
“I don’t understand; which neighbor?
” Well, my old room mate  always called the   nurse right away whenever  she was concerned.  Gloria, my new partner here,  doesn’t. She leaves me be. Then she lectured me. Said  I could leave any  time I want. Any Time!
“How?
“Ask to call a friend.  Talk with your friend to say you are  on your way home, to meet you,  before hanging up,  call a cab- or if there is a problem ask her to send one.  When the cab comes the nurse and everyone will say you are not released. You insist. They make you sign a paper, and the cab driver helps you out. Bingo!
“But you haven’t gone, or done that.
“No. But that isn’t the real point, doctor. The point is I could have gone.
“And?
“Knowing that gave me some authority over my own  life. Some dignity. Independence.
“I suppose that’s something I can’t prescribe, Grace.
“Maybe not, but you might try to keep that in mind, Doc. It’s good medicine.
During the following year I listened to many more of Grace’s  first-person recollections: having a baby during a huge peat fire in Quebec, living in a bamboo stilt hut in Tayabas, Filipinas,  Dengue fever in Laos, learning to walk again  after a year in bed at age 9,  teaching in a 6 student school in  a Chihuahua mining town ; Living in the Cascades of Washington when it snowed 50 feet in Winter.   I told her she can add this memory: teaching her doctor to respect  and remember old folk’s  independence and  dignity.
Thank you Grace, wherever you may be. And Thank you Ray, for introducing me to a time when the art of medicine was the best- sometimes the only- treatment available. I still prescribe some of that medicine , and try to  take it myself, when the technocracy is quiet.
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