A family physician early in her career is moved by the loss of a patient. Today on the blog, she shares a letter she wrote him after his passing. By Aimee English, M.D.
Dear Mr. C.,
There are a number of things I’ve been wanting to say to you since you died three years ago. The first is I’m sorry. Nobody knows what your final moments were like, but I know they were unexpected because you had been at dialysis just the day before plugging yourself into a machine that you hated, being poked by a needle that we had conditioned you to fear beyond reason, just so that your rather poorly functioning heart could keep on ticking for another day.
When I came to work the Monday after you died, I learned of your passing in a way that illuminates the less humanitarian side of medicine—a message in my inbox from a call center representative I had never met stating I must call the coroner’s office to discuss your death and complete the necessary paperwork. I stared at the screen paralyzed for a good minute, then realized I had ten patients on my schedule, buckled down my heartache, saw them, called the coroner, and drove home mourning your death in the privacy of my car.
I am sorry, because you shouldn’t have died alone. About two years after you had become my patient, you came to see me for chronic, intermittent chest pain. You had previously had a coronary bypass and we knew your bypass vessels were obstructed. You were already on the best medications possible to help your heart. I drew a picture of your heart and labeled your blocked rerouted arteries, pointed to the nitroglycerin on your medication list, and tried to let my face show how sorry I was as I let you know there was nothing more I could do, waiting as the translator relayed each of these messages in Spanish. I felt like a failure, notifying you of this truth. You understood my disappointment, replying in English, “It’s okay. You all take good care of me, more than my family.” Most people die with their families beside them if they can. I knew you wouldn’t, but I hadn’t pictured you dying alone, and for that, I am so sorry.
Mr. C, the other thing I want to say to you is thank you. Many hands helped shape me into the doctor I am today, and many of them highly trained and educated. Despite having only a sixth-grade education, you were one of my greatest teachers. When you first became my patient during intern year of family medicine residency, you taught me so many lessons important to the early resident – how to manage diabetes, heart failure, end-stage renal disease, sick versus not sick, and the value of provider-patient continuity.
As I became a better doctor, your lessons became more sophisticated. We danced around tough topics like depression and end-of-life planning. You taught me the importance of being honest when the news was bad, letting the unrealistically optimistic “there’s a slight chance” of intern year grow into the more respectable “what is most likely” of third year.
You taught me how to use my team. Our social worker helped you find housing. Our psychologist helped you talk about depression and gave you exercises to reduce your fear of needles. After months of sending off refills that you never received, our pharmacist discovered I had been sending them to a different Walmart several blocks down the same street as the one you were going to. In fact, when staff around the clinic learned that you died, it was the front desk that took it hardest.
You taught me to be an advocate, asking your specialists to step outside of their guidelines to cater to your individual medical needs that I alone knew. You taught me to look deeper when I realized your improved diabetes control was the result of you eating less because of worsening depression and dwindling money for food.
Above all, you helped me start to learn what it means to be a family doctor. I say start to learn because now two years post-residency, I can see that understanding what family medicine is takes more time than a three-year residency. Because of you, I know that continuity means better care, that lack of financial resources trumps recommended care, and that sometimes my job is about making a troublesome problem disappear, but mostly it’s about helping patients live with problems that don’t go away.
I know that you appreciated me being your doctor, because you thanked me at the end of each visit. I’m sorry I didn’t thank you back. I think you deserved to know how much I appreciated what you taught me over the years and I think you deserved to have died with dignity. I know that you will never read this letter, but other patients might, and I hope that in doing so, they get a glimpse of the profound effect you can have on us, even if we forget to say thanks.
Dr. Aimee English
Aimee Falardeau English, M.D., is a faculty family physician at University of Colorado. Her special interests include patient engagement in quality improvement and improving care for patients with complex needs. She completed a practice transformation fellowship at University of Colorado in 2015 and completed residency at the University of Colorado after attending medical school at University of Massachusetts Amherst.Related reading"Relationships draw resident to primary care" by Eunice Yu"My first patient" by Diana Wohler"In the ER, the call to primary care is strong" by Jennifer Stella