Medicine from the heart . . . Warren Ferguson

March 7, 2013

DV_ferguson_warrenWarren Ferguson, MD, professor and vice chair of family medicine & community health, writes about the moments in our professional lives when we are conflicted between going above and beyond for patients and having it bleed into our personal time, with a mix of emotions ranging from guilt to pride. While we may want to reach for perfection in our care of patients, our efforts need to be rewards unto themselves. Small actions based upon sincerity and empathy offer others in need a great gift.—Hugh Silk, MD

Of Birthdays and Resilience

Regular readers may remember a patient that I wrote about a couple of years ago who I’ve seen every two weeks for many years, enough to now top “a year of visits.” She endured horrendous abuse for many years starting at a young age and, now in her 60s, is very alone in this world. She is the only patient to whom I give birthday and Christmas gifts. I reflect on my visit shortly after her recent birthday.

As I hastily rummaged through sweat suits in the women’s section at Walmart, I was in a grumpy mood. “Why do I over-commit like this. What the heck am I doing out on a Monday night after a long day buying a birthday present for a patient. I should never have asked her what she wanted and just given her a card with some cash like I always do. Tomorrow is my son’s birthday and I haven’t even gotten his present yet; and, we’ve got to get his early applications out to colleges this week! Sigh.”

One day prior, I felt dread when realizing that I’d misplaced my mental note to visit MD (not her real initials) on Saturday at the rehabilitation facility as promised, one day after her birthday. She was spending her birthday in a nursing home for rehabilitation for a knee fracture. I had awoken on Saturday determined to get the leaves cleaned up in the yard and never gave it another thought until late Sunday. On Monday, I had my nurse call to tell MD I’d be there on Monday night.

Walking into the nursing home, I observed that there were a few clients chatting and laughing, getting around in wheelchairs and with walkers. All seemed to be upbeat and happy, not my typical experience in a nursing home. While greeting MD, I apologized profusely for Saturday and she shrugged it off. She had tried to stay up in a chair as long as possible on Saturday while awaiting my visit. My broken promise hurt but nothing like what she’s come to expect from life. She gleefully opened her card and presents; we talked about the storm, the impending election and her knee. It felt like a typical visit to a family member in a nursing home. I was happy to notice my get well card taped on her bathroom door and noticed two birthday cards. Glad to see other cards, I asked her who sent them. “I sent them to myself.” Sure enough, on closer inspection, they said “Get well and happy birthday” and were signed by her. In the car, I was close to tears thinking how alone MD is in this world. I felt so glad to have made the effort but still felt pangs of guilt for being late.

A memory immediately popped into my head about my son’s fifth birthday party, 13 years prior on the same date, a swim party at the downtown YMCA in Worcester. In the family locker room, I had run into a mother and her three children for whom I provided care. She came to the Y with kids to shower on weekends as it was too rushed to take a decent shower in the shelter. After swim, Mike was opening presents with friends and parents while all enjoyed cake. Three sets of eyes belonging to my three homeless patients looked longingly into the windowed room. I immediately invited them in for cake and ice cream. I can still remember the astonishment on the youngest boy’s face when he realized that Mike was getting more than a single birthday present. He looked like he had seen an alien.

My reflection rapidly shifted from morose pity to consideration of resilience. The nursing home patients had developed a real sense of community. MD was so smart to send herself birthday cards in lieu of being completely alone on her birthday. That mother was innovative in making homeless shelter life less burdensome for herself and her family with gifts of long, hot showers. I was glad to have checked my pity at this door now. Empathy, I thought, requires recognition of strengths.

Calm washed over me with my resolve to try to relieve suffering as part of my role as a family physician. At the same time, I offered myself forgiveness and felt proud for a job well done.

Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit:

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