Sometimes a Pill is not Needed

The Importance of Conversation

As a volunteer physician in Merci Clinic, I am allowed to spend as much time as needed with each patient. Unlike general private practice which requires 16 to 20 patients a day to reach my quota with insurance premiums, in this clinic setting there is usually ample time to work through a problem. The following is an illustration.

A middle aged lady allowed me into her examining room and displayed a worried and grim face. When I asked for her troubles, she revealed that over the past few months she has had a heavy chest and difficulty in breathing. “Some days it is pretty good, but on other days my chest feels very heavy.”

So we spent some time finding out her history. She had coronary artery disease about 18 months ago, and at catheterization, received a stent into the one partially obstructed coronary artery. She was given the appropriate medication for this and has faithfully kept up with her medicines. The heavy chest and difficult breathing seemed to be in some days all day, but not on others. It was not related to exercise or sudden changes in emotion.

After sifting through several ways of checking out her symptoms, I determined that the likely cause was not organic or structural. So my next question was for her a really important and illuminating one! “So what is on your mind a lot these days?” She burst into tears and I reached for the tissue box. It turns out that her youngest 21 year old daughter is pregnant and Mrs. Jones, who has raised all three children as a single parent, was very concerned that she “might not be able to see her granddaughter grow up.”

And then the conversation began to flow. She talked and talked. I was able to remember some advice from my days as a hospice doctor. I told her that right now I did not feel her symptoms were life-threatening. And I gave her three longer term options to provide important feelings for her granddaughter.

1) A hand written letter to her granddaughter telling her all about herself and her dreams for this new baby.
2) Snip a small amount of hair to be placed in a locket for her granddaughter to wear whenever needed. 
3) purchase a Raggedy Ann as a gift to remind her granddaughter who would be with her for the rest of her life.

At the end of the interview, Mrs. Jones got up and said “Now my chest is no longer so heavy and I can breathe much easier.”

Anonymous MD