Adopted

The practice of family medicine occurs within a two-way relationship between doctor and patient: if we let them, patients repeatedly care for us as much as we care for them. In my case, patients are sometimes very patient indeed as they wait for me to discover this simple truth over and over again, fumbling in ignorance of their lives, their stories.

I still remember meeting Willie: “Doctor, I’m so glad to see you! I have troubles, I declare I have more troubles than I can count!” Eyebrows furrowed, hopeful smile on her lips, her voice announced her childhood in the piney woods along dirt packed roads in the Piedmont area of North Carolina. I pictured her as a barefoot child, pinching tobacco, chasing her brothers to school when they still went.

She unleashed an array of difficulties in no particular order and with fervor for each: abdominal pains, breast cancer resected a few years back, new rectal bleeding, high blood pressure, diarrhea, but especially a rash for which, oddly enough, it was her psychiatrist who had suggested she take one medicine then another. As she spoke, I saw a virtual museum collection of bandages covering many of the crusted ulcers on her arms and legs. Some of them oozed pus, the surrounding skin more erythematous.

Against the odds and despite my puzzlement, we muddled through our first encounter, and Willie and I moved onto a tolerable doctor-patient relationship. She would show up from time to time on her own schedule, sometimes even stringing together a miraculous 2 or 3 visits in a row dealing with the same problem. We struggled with her infected neurodermatitis, did an occasional breast examination, got annual mammograms, just as she wanted. We checked her cholesterol, blood sugar, and blood pressure. She saw consultants, sometimes, after I had recommended it often enough. Every so often, she begged me to start her on “diet pills to get some of this weight off ’cause I have an important wedding to go to next week!” She never seemed to mind when I declined, but would beg just as intensely the next time she had a baptism or maybe a church supper to attend.

In between all her problems and words, I learned some tidbits about Willie: 4 kids, husband gone who knows where, a passion for reading and travel, despite her limited income. But I struggled to keep us “on task” with my medical agenda. I tried so hard to concentrate on her illnesses that I never really got to know her.

Then one day, my hand on the doorknob, I was about to leave the examination room, when she said quietly, maybe even slowly, “Oh, one other thing, Doc, what can you do about this arthritis that’s been eating at my shoulder for the last months?”

“Which shoulder, Willie?” I asked, a sinking feeling starting in the pit of my stomach.

“Oh, my left one, especially when I walk upstairs, and you know, I get a bit short of breath then, too.”

Yeah, I figured. “Willie, let’s get you back up on the examination table and check you some more,” I said, knowing my patient schedule for the rest of the day was blown.

She soon underwent successful angioplasty for some mean-looking left main coronary artery disease. A few months later, I saw her as I wandered the clinic halls trolling for residents to precept. She was waiting for a blood draw, ordered by the cardiologist. “How’d you like him, Willie?” I asked.

“Oh, he’s good enough, I guess, but doesn’t come close to your bedside manner, Doc!” I told her I would be away a few days, and would let her know the test results when I got back. “Oh, that’s okay,” she said, “but I hope you’re going to be away for pleasure, ‘cause you sure look tired like you’ve been workin’ hard lately. You sad or just worn out? I hope you take care of yourself once in awhile.”

“Well, yes, this time it’s a family vacation in California.”

“California!? Oh, Doc, I had the highest best experience of my life there. I spent a month in California back in the 50’s. I was on one of those TV quiz shows. Went all the way to the top. And you know what the best of all was, Doc, without even telling me ahead of time they gave me the surprise of my life.”

Relaxed, in no medical hurry, with no pressing responsibility to “manage” her health care, I leaned against the wall, smiling in fascination and affection. “Tell me about the surprise,” I said.

“Well, first I have to tell you about Europe.” I’ve never heard of you being in Europe, I thought, blushing. “It was near the end of the War, and I went over to be a radio announcer for the troops and all? It was my job to read letters from home to the American soldiers. I’d get letters from their sweeties or wives. You know, ‘To PFC Eddie McDonald, your girl Louise says she’s waiting for you, stay safe, win the war, and hurry home.’ They called me ‘The Paris Magnolia’ and the boys over there, they were so grateful for me telling them just a word or 2 from home.

“Well, one day when I was walking to my apartment, I saw this darling little fellow, maybe 3 or 4 years old, running with a gang of older orphan street kids. So I just marched over to him, took him by the hand and carried him home to my apartment. I searched his kin for weeks. He said they had been killed but I had to be sure, and you know what, we never did find his parents, so I just sort of took him in. Got him some darling little clothes my girlfriends back home made for him. I washed him, combed his hair, fed him up, and turned him into a regular little French gentleman. Pierre, I called him, and it sort of stuck. Well, when time came to go back home, I couldn’t take him with me. Totally broke my heart, but I couldn’t have kept him, me just a 20-year old single girl and all. Anyway, I knew this married American fellow who lived nearby, and he had taken a real shine to Pierre, so he agreed to keep him when I left, and wouldn’t you know it but I heard he took him home to his wife and their 2 little kids in Connecticut.

“And that TV show? Well, Pierre was my secret, of course, and none of the panelists guessed about him, but right near the end, the announcer said, ‘Willie, you saved a little boy from the streets of Paris many years ago, didn’t you?’ Yes, I said. ‘But you haven’t seen him in the nearly 10 years since you left Europe, have you?’ No, I said. ‘Well here he is!’ and you know what, I looked across the stage, and there was Pierre, running toward me, arms out like this. He was a fine-looking 13-year-old by then, of course, but I recognized him right away and just started running too. and you know what? That was the end of the show, with the two of us just huggin’ and cryin’ in the middle of the stage. It was the high point of my life. Just the highest point. I’ve never had anything to equal it.

“And you know what, my heart is the last part of me that I would have thought to go bad, but I’m so glad you know me well enough to get it taken care of just right!” She smiled and laughed an open, grateful laugh. “Doc, I want you to take care of yourself too, and let me know whenever I can do something for you and your wife, maybe make supper some day when you both don’t have the time, okay?”

Through a blur of tears, I smiled back and thanked her for the compliment and kind offer, for which I felt decidedly undeserving. I was amazed at the recognition and support she gave a fellow sufferer by simply telling a story and offering a meal. Looking back over our time together, I was sorry not to have seen sooner the steel in her caring for others, not to have let down my doctor role to accept her caring for me. But she was patient, in no hurry to rush my ability. When I was ready to accept, she offered thanks, forgiveness, and hope. I felt that, like Pierre, I had been taken in off the street and adopted.

• Received for publication May 20, 2003.
• Revision received May 20, 2003.