End of a Beautiful Relationship

This past week for the last time I traveled 70 miles to have a final physical check-up exam with the family physician whom I have been seeing regularly for 35 years. He is retiring this year. During the past many years I have been his patient for whom he exhibited great patience. Outside of the relationship I have had with my children and siblings and one dear, dear friend, my relationship with this doctor is the longest one of my life. I am seventy-eight years old and it is doubtful that I will have opportunity to enjoy such a long relationship with another physician or really, with anyone else. Our intimacies were profound; I have allowed this man to probe every orifice of my body, and he did so gently and unreservedly at least once every year for each of the thirty-five years; sometimes if my hypochondriacal tendencies flared I visited with whom more than once in a year. I remember once, years ago, arriving home one Sunday evening after a personal trip East and driving directly from the airport to the emergency room of the hospital to relievedly find him there on duty: I learned that he was also an emergency room trauma doctor. I was having difficulty breathing and the admitting nurses thought that perhaps I was having a heart attack. I wasn’t and I almost knew it, though in my hypochondriacal fantasies I could have been experiencing a myocardial infarction having never had one before and knowing only what it looked like from the television shows I watched. And that night in the emergency room—because it was late and I was frantic—he cared for whatever was wrong with me physically and psychologically. Over the years with his attentions, he gave me the freedoms that I sought so that I could think myself healthy, and he supported me when I was suffering actually or hypochondriacally. He listened to my plaints and took me seriously in either case. When I would ask for a procedure—a colonoscopy, repair of a trigger finger, the freezing off of keratosis on various places on my vain body—he would right away order that precise procedure. At some point we actually did discover some real cardiac issues and he sent me to a specialist who was very skilled but was also too busy or disinterested in me as a person to listen. The cardiologist performed an endoscopy, discovered a bicuspid valve and an aortic aneurysm, and made some direct recommendations; I never saw him again nor would he respond to my phone calls. Of late I have experienced an outbreak of eczema and recorded the shortest doctor’s appointment ever—two minutes—and I left with a prescription. But over the years, visits with my family physician did not last less than twenty minutes and often extended to forty-five minutes and sometimes to an hour.. I always left his exam room feeling relieved and healed. On the last visit this past week, at the end of the exam we embraced and said goodbye. We had never done that before.

I had begun my visits with him when I had moved from New York to Menomonie, Wisconsin, the latter a semi-rural town harboring a moderate sized university that was a part of the University of Wisconsin system. I was a member of the faculty there. In New York I had not thought to ever need a family physician—I was young and my body seemed to function as it was supposed to and it did so mostly in silence. I also didn’t have the slightest idea how to find a doctor even if I knew what I was looking for in a primary care physician. I don’t think I ever had heard the term before I settled in Menomonie. In my twenties I became a long-distance runner, and I began to pay greater attention to the states of my body and especially as my body began to make some unfamiliar noises: my knees and feet would hurt and so they said I ought to see a podiatrist. He prescribed orthotics that seemed to work best when I held them in my hands. As a runner I learned to pay attention to my body and it talked back at me regularly. I began to notice every twinge and twist. But back then I did not have a family physician and attributed any ache and pain to the number of miles I had run that week.

 But when I moved to Menomonie with wife, child and two cats, I thought it advisable to seek out a family physician, and I asked my all-in-one holistic advisor, massage therapist and health product dispenser for a recommendation and she advised him because he was sympathetic to alternative treatments and medicines and was a good listener and by reputation a good doctor. I made my first appointment. I suppose our initial meeting was like a blind date!

It is ironic now to consider that it might have been his patience and his proximity that fertilized my hypochondriacal tendencies. He was so close and the clinic so relatively small that at any ache or twinge, slight as it might be, I could make an immediate appointment, drive to the clinic, and he would diagnose . . . usually not much was amiss though he would advise me in a soothing language and tone that, yes, I was going to live. When it became available, I added myself on to the patient portal where I could view a lot of things medical—appointments scheduled, test results most of which I could not understand. On this portal a patient could send messages to their care team and on which they might respond. I took frequent advantage of this means of communication and he patiently and with concern responded within twenty-four hours and usually in much less time, even when he was not even scheduled to be in the office. Though doctors take days off, his care of me knew no pause or impatience. When more serious conditions arose, he either treated me himself or directed me to appropriate specialists all of whom were skilled and none of whom were available as was he. He always was so.

And I am wondering what is now gone, and what does it mean to have lost his care. In that final visit he handed me a xeroxed sheet of available primary care physicians and recommended a few I might try, but really, he did not speak with any great enthusiasm. And it was like an experience of on-line dating: who “looked” right! Maybe he was experiencing a loss as well, not unmoved to arrive after thirty-five years at an end of our times together. During those years he and I have shared marriages, divorces, and re-marriages. We would speak of our children and their growths and difficulties, their marriages and our divorces, and finally our children’s children’s activities. We had never met outside of his office in which we shared intimacies that I do not believe we would have presented outside of the office. In there was sacred space, not, I suppose, unlike that of the confession booth. I am not sure I would have ever wanted to meet outside of the office. No place could ever be as intimate as was that exam room space. We were not friends or lovers; but if love is to care for the other, then he loved me. He was my loving caregiver. 

I think I am now too old to develop an intimate relationship with another physician. Oh, I talk to my cardiologist but . . . well, that conversation is always focused on my heart and its issues and does not begin to enter into the personal stuff I always shared with my primary care physician. In my cardiologist’s office I don’t even have to take off my clothes, though it is true that in the winter when I wear many layers I have to partially de-layer so he can hear my heart! No, over the 35 years of medical visits with my family physician developed an intimacy I expect not to experience again in a doctor’s office. As I age the world around me grows smaller and less populated, and I will miss my relationship with him.