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A Familiar Patient

by Gelareh Homayounfar

My patient is 88 years old, but she tells me that someone once told her she would live to be a hundred. She says this happily and responds with "oh, wonderful" nearly every time I share an encouraging test result or our team's plan for her care. Part of me wonders how much of this pleasant, accepting manner is due to her diagnosis of dementia, but seeing things in a positive light as I tend to do, I imagine she must have been a lovely person when she was younger, too. Her son shows me a picture saved on his cell phone of his mother holding him, then an infant. "Mother used to be beautiful, like Grace Kelly beautiful, " he says. He wants me to see her as she looked then, in contrast to her aged, bruised face now, after a recent fall. I look on, thinking that she's still beautiful and that she must be a wonderful mother to inspire such devotion in her children. I share only the latter thought with him, remembering my instruction on maintaining professional boundaries between doctor and patient.

No boundary can keep my mind from wandering toward the fact that this family reminds me so much of my own. Though we are at different stages of life, the similarities between us are both substantive and coincidental. This son's tone of voice when speaking to his mother is much like my mine, reflecting love, admiration, and respect. My patient once worked as a nurse; so does my mother. We all once lived in the same state. I wonder what the future holds for both families. My family is healthy now, but the hospital is a daily reminder of how lucky we are. Rather than making me fearful of the future, this family and their response to dementia reassure me. They seem to be a model of effective coping and embody the decision to value quality of life. It really can be done, I think! I know that one day I may start to lose the mind that is at the core of my self-concept. Or I may see one of my parents go through the same process. Three years ago, I went to a hospice on a field trip of sorts, as part of a course on end of life issues. Our professor asked the group of students, most in our early twenties then, how many of us thought of the possibility that we may one day be like the hospice residents. I was surprised to find myself the only one raising a hand. As my peer group gets older and loses the feeling of invincibility of youth, I doubt I'm as alone as I was then in allowing myself to acknowledge the possibility of shared experience. This acknowledgment makes me more empathetic towards my patients and, reciprocally, more accepting of frailty in my personal relationships.

Not all of my patients remind me of my family in quite the same way. The commonalities aren't always as obvious. This is only natural. Nevertheless, even if not obvious, I know that there are always commonalities to be found and will always strive to care for each patient as I would want my family to be cared for.

Gelareh Homayounfar is a third-year medical student at Harvard Medical School in Boston.


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