Medicine from the heart . . . Chris Garofalo, MD

On Thursdays, 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: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.

Chris Garofalo, MD, a graduate of the UMMS Family Medicine Residency Program at Hahnemann Family Health Center, is a community doctor practicing at the Family Medicine Associates of South Attleboro. His reflection reminds us of the power of a simple gesture and how the act of caring can be so important for families in times of need.—Hugh Silk, MD

I met Maria in April 2008. She had Crohn's disease controlled on Humira. However, within a few months the Humira caused progressively worsening interstitial lung disease. Stopping Humira was not an option as her Crohn's flared severely when we tried. As her functioning diminished she began to rely on her husband, Lenny, crusty public school bus driver and also a patient of mine.

She was transitioned to hospice in July as her condition continued to spiral downward. Meds were simplified, symptoms controlled w/MSO4, respite provided for her husband. She died in October 2009, comfortably, at home, with family and friends. It was a peaceful death and I felt that hospice care was used effectively.

A few weeks before Maria died my daughter Olivia was invited to a classmate's birthday party, Sofie B. Several days before the party I read Maria's obituary and saw that one of her daughters was Mrs. B of North Attleboro. Couldn't be a coincidence, I thought as I drove Olivia to the

party. I didn't want to cast a pall over the party by revealing my relation to Maria but I worried that it would be more awkward to have them realize this after the fact so I elected to introduce Olivia using her last name.

As expected, Sofie's mom recognized my name and started to cry after Olivia left to be with her friends. She thanked me for taking care of her mom and her dad, who was managing “better than expected.” When I picked up Olivia, they were eating cake so I hung back a bit. Lenny was across the room. He saw me and immediately worked his way over. I put my hand on his shoulder and said how sorry I was that his wife had died. We chatted a bit about his wife, her illness, and how he was doing.

Our family's lives crossed again when Sofie came to our house on Halloween. Then my wife was volunteering at Olivia's class Christmas party. My patient's daughter saw her and expressed her gratitude that I came to the birthday party and took the time to talk to her dad. Her dad particularly mentioned the kindness shown to him by placing my hand on his shoulder. This was such a small gesture on my part but played an outsized role in his healing. Living in the same town in which you practice is not for everyone, but I feel it brings significant benefits to my patients.