Photographs and Memories ... The Joy of My Patients’ Faces
Christine Navarro, MD
Kaiser Permanente, Los Angeles
He was looking more cachectic today. Mr. Regalado was a few minutes late for his hospitalization follow-up appointment. As always, he was accompanied by his wife and daughter. We all crowded together in the smaller of my two exam rooms.
“How are things since the hospital?” I asked. He shrugged his shoulders like he always did. He was a reluctant patient. I started seeing him after his wife, Regina, urged him to see a doctor. I “inherited” Mrs. R. when her doctor moved away and, since he always drove her to her appointments, she made an appointment for him as well. Over the years, I taken care of her during cardiac bypass and managed her diabetes, hypertension and depression. Our visits tended to be long talks about their family and how she is managing the stress caused by their grown children. Her hospitalizations included spinal fusion and knee replacements, and most serious of all, was a staph infection which resulted in a significant removal of her thigh muscles.
Mr. Regalado was a different story altogether. I was never successful in convincing him to stop smoking. He was a stoic, taciturn man who resisted making any commitments to change. When I asked his wife and daughter to step out of the room so he could be interviewed alone we were like awkward strangers who could not sustain a conversation without the more garrulous women. When they were present for Mr. Regalado’s appointments he deferred all conversation to them. He was hospitalized twice – once for a bleeding peptic ulcer and another time for a heart attack. Neither event scared or motivated him enough to make any significant changes to his habits, causing much of the frustration of his family.
Now, Mr. Regalado was coming in following a third hospitalization for lung cancer. He spent a couple of weeks in the hospital for post-obstructive pneumonia. He had bronchoscopy and a biopsy, which revealed what we feared: he had progressed lung cancer. Another hospitalization quickly followed for recurrent pleural effusion. He lost weight and his appetite was gone. His wife and daughter took care of him and he could no longer drive.
I asked him what he wanted and he answered unequivocally, “I want to go home.” He said this with more force and conviction than at any other time during our relationship. We discussed hospice and he said, “I want that.” His wife and daughter were silent. I had a feeling that this dynamic was one they have dealt with before. I placed the hospice referral and gave him his final prescriptions. As we were walking out in the hall I stopped them and I reached for my phone. “May I take your picture? You may not be able to visit me here again,” I said. Husband and wife stood in the hall as the cacophony of a busy clinic practice swirled around us. I took a couple of photos and texted them a copy. With that, we walked out into the waiting room.
One Friday, few weeks later, I received his death notice from the Hospice Service. I was unable to reach the family by phone. The next Monday I received a message from their daughter inviting me to “their services.” This sounded strange and I thought I made a mistake in listening to the message. When I finally reached Marie, she told me that Mr. Regalado died peacefully at home on Friday … and Mrs. Regalado suffered a massive stroke the very next day. She was brought by EMS to the closest university hospital where she died. It turned out that she couldn’t live without him. “They both really liked you,” she said, “my mom had utmost faith in you and my father went right along.”
I kept looking at this last picture I had of them together. Little did I know it would be the last time that I would see Mrs. Regalado as well. I thought about this for a long time. Both patients came into my life early in my career. They met me when I was an intern, saw me pregnant with my children and listened to me talk of my own parents’ illnesses. They were proud that I was their attending physician when they were hospitalized. I grieved for them like a daughter.
As I gazed at their picture, I came to realize the value and the power of the final photograph for me. I started a “selfie project” with my patients. Over the last few years, I’ve selfies with the “old timers” – my patients of 10 years or more. I am surprised how willing they are to have their pictures taken with me. My 101-year-old Dodger die-hard patient who could barely hear posed with his 86-year-old wife. Another patient who battled emphysema and breast cancer died not too long ago after our photo was taken; I sent our selfies to her daughter at the end. The photographs have become a document of the intimate bond of doctor and patient. They have been powerful tools in the renewal of my sense of purpose at work. Taking the pictures reaffirms, strengthens and acknowledges that our relationships have deepened with time and it is amazing to see the joy my patients have when I ask to do a selfie. They pose with trust and true affection. Perhaps, it is in this reflection that I have given myself the gift of building resilience and just like looking at family albums, I look at the pictures and find the joy in my work through the faces of my patients.