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!
“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.
“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.