Linda R. Duska, MD
25 Jul 2012 3:21 PM
Not many of us make house calls anymore. Certainly not those of us in academic medicine. There is just so much to do: patients to see, research to conduct, grants to write and rewrite. A house call can take up the whole day or more. A house call for an oncology patient at the end of life is also emotionally exhausting. But a house call can give us as providers a special insight into the intricacies of family and caregivers at the end of life that can’t otherwise be achieved, and for the patient and her family can be a moment of connection with the health care provider. It can also give all of us closure.
I’ve been practicing gynecologic oncology for almost 14 years. In that time, I have gotten close to a lot of my patients, particularly those I have cared for through the end of life. Patients with ovarian cancer, in particular, are patients that we as providers often know a long time, over many courses of treatment. In my practice, I don’t just give them chemotherapy: I give them the original diagnosis, I operate on them, I sometimes operate again to help fix bowel obstructions to give them a few more months of quality life. And in this process, I have gotten very close to many of these patients and their families.
Yet, I can count the house calls I’ve made on two hands. Each one is very fresh in my mind. And each one I know that I really made for the family and not for the patient herself, since in most cases the patient was really already gone (even though she was still alive). I know that I also make these house calls for myself.
I don’t talk about the house calls with my partners; I’m pretty sure they don’t think it’s a good idea. They are very hard for me to do. I’m not just an oncologist, I’m also a surgeon. We believe we can fix things. I know that advanced ovarian cancer is a bad disease; I am very honest with my patients about this. Yet, when the patient is dying, I almost feel as though I have failed her and her family. I know intellectually that’s not the case, but it can be hard for me to be with the family at the end of life, particularly in their own home, and face my failure.
I usually take someone with me on these house calls. Once I took my small daughter (she was probably 12 at the time), and she sat on the stairs with my patient’s daughter (not too much older) while I went to see her mother and sit with her father, just listening to his feelings of loss. Once I took my husband, since the patient lived two hours away in the mountains, and he was worried I wouldn’t find my way to her home at night. He sat with her husband while I visited with her. She died as we drove back through the mountains on our trip home; my cell phone did not get service, and I didn’t get her husband’s message about her death until we reached home.
I still hear from most of these families. I remember their homes and our time together very clearly. They email me mostly, although some of them send me handwritten cards each year. I know that they appreciate the time I spent with them in their homes at this critical juncture. But it wasn’t just for them; it was for me as well. I know that death from cancer isn’t my failure; there are some things you can’t change. Sharing in that most personal and intimate time with the family and their loved one at the end of life is sometimes what I need to remind me of that.