Medicine from the heart . . . Allison Hargreaves
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.
Boundaries
As a physician I often wonder about boundaries. I know it helps some patients to know me as a person, especially if I have experienced what they are going through. I don’t think anyone would fault me for telling a 5-year-old that I too have had stitches and I know what it’s like. But what about more personal things? Love and loss, birth and death? How much of myself can be shared with my patients? What is considered “appropriate” and who decides?
As a mother, my number one goal in life is to protect my daughter, keep her safe, ensure her happiness. I have certainly respected more boundaries as a result of this shift in my priorities. Gone are the days of staying at the health center until 10 p.m. to do paperwork (and let’s face it, procrastinate). I no longer say “yes” immediately to every project, opportunity or commitment that comes my way.
The other day I blurred all kinds of boundaries, and my daughter was involved, which has prompted some reflection. I have this wonderful patient, a woman in her 70s who has had a recurrence of colon cancer and is living her final weeks. She remains feisty and spirited, and our goals have recently evolved from prolonging life to ensuring quality of life. I have developed a close relationship with her and her family. They can reach me at any time on my cell phone (boundary breach?). The other day her son called and told me that all my patient could talk about was how much she wanted to meet my daughter. It didn’t take long for us to arrange a home visit.
I would never put my daughter, now 16 months old, in any danger. My patient is actually very healthy, aside from the relentless cancer cells infiltrating her body. But I couldn’t help but wonder if I was somehow exploiting my child. I called the one person I can always count on to tell me when I’m making a mistake—my mother. She offered her seal of approval, so off we went.
We arrived at my patient’s house and she was ready and waiting to meet my little bean. She had bought her a stuffed lion and a book, which my daughter took to immediately (boundary breach?). She also had a bin full of old toys that used to belong to her grandchildren, now older. While I watched the two of them playing with smiles on their faces, looking like they have known each other forever, I wondered how I ever could have thought there might be something wrong here.
The spell was temporarily broken when my patient’s husband asked if my husband was also in medicine (boundary breach?). I find it awkward telling members of this generation that I do not in fact have a husband, but I also cannot lie. So I told him that my daughter’s father is a paramedic but that we are not together. My patient must have sensed my apprehension because she asked me, point blank, “Are you happy?” I told her I am. And then she pointed at my giggling daughter and said, “Well, clearly she is happy, so good for you.” I think she and I both benefitted from that visit.
We left after a while and I told my patient I would be back in a few days with her flu shot. We exchanged hugs all around (boundary breach?). I left feeling pretty good, and my daughter hugged her new toy on the way home.
Maybe this narrative is one giant boundary breach, in that I have shared too much. I still don’t have the answers, but I have to go with what feels right to me. And this particular encounter definitely felt right.