STELLA

Narrative knowledge allows and encourages human connections.
— Julie Connelly, “In the Absence of Narrative,” 2002

I learned a very important lesson one afternoon last summer.  At the time, I was medical director of the local hospice, a part-time position that required visits to patients in their homes. Most of the visits were scheduled, but sometimes situations changed, emergencies happened, and I was needed right away.

That day, the nurse called me at home where I was writing. It was an afternoon that I had looked forward to as a time to get some of my own work completed.  She told me that last week an elderly man was visited at his home by his family—a usual weekly visit. He seemed to be doing well enough, but today their visit was different. He was in distress.  They called for help and all reports suggested that he was dying; the nurse needed me to go see him right away.

I arrived at his home after a 40-minute drive.  In the yard where I parked, I was met by a hospice nurse, the patient’s granddaughter, and his daughter.  We talked outside for a few minutes, where they described their concerns and the changes in his condition that had occurred in the last week, and then we went in the house to see him.

The white frame house was surrounded by an unfenced yard, lilac bushes were in bloom, and a yellow and white cat ran across the back door.  Inside, we entered a porch, then moved into a large dark room where books and magazines were piled high, boxes of collected belongings filled the space, and clothes were neatly folded in an overstuffed chair. In one corner of the room was a double bed where a very frail 94-year-old man was lying on his back, his eyes sunken deep, and his head propped up on several pillows.  He was totally alert and present to all of us entering the room. He looked at me and said, “I know you, yep, you took care of my wife when she was at the nursing home.” I didn’t recognize him at first, but then I began to remember his wife, her illness and death several years before at the nursing home.

As we talked, he told me that he had been nauseated and unable to drink anything for the last five days. He said that his “belly” hurt, and he wanted a shot so it would stop hurting; he also said, “I really want some lemonade. I’m so thirsty.”  When I asked him about his medical history, he said, “I’ve never been sick before. I’ve never been to a doctor, never to the hospital, and I don’t take any medicines.” This was so remarkable for a 94-year-old—no history of being ill at all.  I was amazed.  Happily I said to him, “Wow, you are a lucky man!” I was sitting next to him on his bed.  He stopped and looked straight into my eyes with an incredible intensity. He said, “I’m not lucky, I’m blessed.”

For a while after the nurses got him settled in a clean bed, he sipped cool lemonade, the only remedy he desired for his thirst. Then he rested his head back on the pillow as a smile appeared. He closed his eyes.  Later that night he died.

— Julie Connelly, MD, 2013

Julie Connelly is an internal medicine physician, photographer, and writer who explores the value of narrative for medical professionals through her pictures, essays, and stories. She is the author of an essay entitled “In the Absence of Narrative,” in the collection Stories Matter: The Role of Narrative in Medical Ethics (ed. Rita Charon and Martha Montello), in which she makes the case for creative reflection in improving physician-patient relationships and empathic medical care. Though luck, whether good or bad, may bring physician and patient together, Connelly demonstrates in this and other narratives how the lessons of physician-patient encounters at the end of life may reveal themselves as simple, yet powerful, blessings.

— LC