Sometimes your experience with one patient encapsules your entire philosophy as a clinician. Kim Zuber shares her memories of George, who taught her to ask about people's lives, not just their ailments, and really listen to what they share in response.
We buried George today. He died of the usual consequences of old age: heart disease, hypertension, kidney disease, Alzheimer’s. However, I cannot think of George without a smile on my face and a thank you in my heart. You see, because of George, I am a better practitioner … and a much better storyteller!
George first came to my clinic for patients with chronic kidney disease many years ago. He had failing kidneys as a result of his hypertension and needed closer monitoring than we were presently able to do during office visits alone. He arrived with his daughter at his side and a scowl on his face. As he took off his coat to have his blood pressure checked, I noticed that one elbow was red and swollen. I asked him what had happened. He said (and I quote): “The General cheats!” His daughter rolled her eyes.
The story, as told by George and supplemented by his daughter, is that George and “The General” (in seven years, I never did learn his actual name) had a standing racquetball date on Friday mornings at Andrews Air Force Base; then they would go to lunch. You see, before the indignities of aging caught up with him, George was a feared and respected Navy Admiral and a good friend of The General. Both George and The General were in the mild to moderate stages of Alzheimer’s and argued frequently over scoring during their racquetball game. In practical terms, the score was a fluid idea that was always wrong, and neither George nor The General ever had any idea what the real score was. However, as aging warriors are wont to do, they insisted on arguing every point, even if they could not remember what the point was! In fact, during these Friday morning racquetball games, there was an MP posted near the door to help The Admiral and The General negotiate.
In the Washington, DC, area, we are defined by what we do. The first question anyone asks is “And what do you do?” This can be a put-down, but more often than not, it is a stepping-stone for fascinating discussions. When I meet you in my office, though, you are older and retired, and society tends to consider you not as vital. I have a social history in your chart, but that’s not the same as asking you about what you do. I have the older gentleman who always arrives alone and whose chart says he’s retired from working at National Geographic. That is not the same as knowing he was the videographer for 40 years of National Geographic specials about climbing K2, swimming with sharks, hiking the desert, or canoeing the Amazon.
Knowing this explains his neuropathy: hours of standing in rivers. His amputations: frostbite at the tips of his fingers and toes. His single status: As he explained to me, “I never really had much time for a wife or kids.… I was always traveling so much.” If I had not asked him more during the social history, I would have missed out on many a great story.
I have met retired Secret Service agents, the public relations man for the US Postal Service who was the driving force behind the “Donate Life” stamp, a 15th-generation relative of George Washington, a survivor from D-Day. I have gotten tips from a mom on how to put up with a 15-year-old without killing her, stories of what it was like to be the first black man with a degree telling Southern whites what to do, what it was like to volunteer at the White House, and what it was like to build a bridge. I have learned about history and geography—as well as patience and wonder—from the stories I have heard.
There is a Jewish retirement home in Rockville, Maryland, near my office. The gerontologist who runs the home specializes in Alzheimer’s, and many of the residents there are in different stages of the disease. However, Rockville is near the NIH, the National Cancer Institute, the Genome Project, the FDA, the National Institute of Standards and Technology, the US Navy Research Lab, and the Goddard Space Center (NASA). There are more Nobel Prize winners in this 10-square-mile area than in any other place in the United States. As the gerontologist has told me, “These patients are the most brilliant minds of two generations. They could lose 75% of their brain function and still be smarter than I am.” As you can imagine, any mini-mental test or standardized Alzheimer’s protocol is totally ineffective for these residents. A detailed social history is more important than a “one-size-fits-all” mental screening test.
I used to feel that patients should be told what to do. After 27 years of practice, I no longer believe that. I cannot cure your kidney disease; you will eventually die on me. All my patients do, just as George did. But I want my wake to be like George’s—with stories, and friends, and laughter. If we are to pass this way only once, let us enjoy the time we have together.