The Message

The Message Anthony A. Donato MD, MHPE, MACP Associate Program Director, Reading Hospital – Tower Health Internal Medicine Residency Program Professor of Medicine, Drexel University College of Medicine

I met Grace* years ago when she was admitted with a frustrating lower gastrointestinal bleed. She was in her eighties, nearly blind from macular degeneration, and crippled from significant arthritis, but neither could dampen her wit and humor. Grace loved to tell jokes and her infectious laughter guaranteed amusement for all. She was one of my favorite patients and I even visited her a few times after she had been assigned to another physician.

Aside from an occasional card from Grace, our paths did not cross again until years later. She was admitted again, this time suffering from progression of her arthritis and now an abscess that made it nearly impossible for her to get comfortable. She was admitted under another physician’s care but happened to be the roommate of a patient of mine, giving me the opportunity to stop by multiple times a day.

Only I didn’t. Or couldn’t. I could insert whatever busy hospitalist excuse that I could come up with - her roommate needed a lot of attention or the hospital was super busy with a flu outbreak. For a million reasons, I just didn’t make beyond a cursory greeting as I dashed in to fix her roommate’s latest crisis. Nearly two weeks later, I was surprised to see her on the hospitalist census. This time I was not on a clinical service and was out of excuses. Finally sitting at her bedside, I found that Grace was about to be transferred to a nursing home, and she was feeling very down. We exchanged a joke or two, but she told them without her trademark laugh. I introduced a conversation about her life goals going forward. She wanted to make it to her grandson’s graduation but was beginning to believe that it would not happen. She still was in too much pain to sit due to her abscess and had not stood under her own power in weeks. She was willing to try therapy,

but not very hopeful. I then asked what gave her strength in tough times.

“Give me my phone,” she said. I handed her the museum-ready flip phone on the table, expecting her to show me a picture - a pet, her daughter, the grandson who was about to graduate, or perhaps her late husband. “Play saved messages,” she said to the phone.

“An odd time to see if the cable guy called,” I thought to myself.

“Here,” she said, passing me the phone.

To my greatest surprise, I heard my own voice. I had apparently called to thank her for sending me a Father’s Day card 19 months prior. It wasn’t funny, clever, or even witty. It was just a brief thanks and a reminder that I was thinking of her. “That. That message sustains me when I am down. I just play it and I feel better. My daughter almost erased it and I about killed her.”

That call- less than thirty seconds- was all she needed. Yet I hadn’t been able to find thirty more seconds in the previous two weeks.

It’s easy to get lost in our work as physicians. The pace is relentless, and digesting data is akin to drinking from a fire hose. But opportunities for small acts of kindness and moments of presence - almost always trump an exhaustive list of differentials.

*The patient’s name has been changed.