Finding Mary at Home: Learning Through House Calls

On Friday afternoons, I visit Mary. We sit together by her kitchen window near a hibiscus that sheds its leaves throughout the winter. Mary is my friend. She is also my first patient as a first-year medical student. We were paired together as part of a longitudinal patient experience. The assignment is simple—build a relationship with a patient beyond the clinic. The things I have learned about Mary “beyond the clinic” have been invaluable. How else would I know that she spends most of her days alone and idle? How else would I see that just fetching a glass of water saps much of her energy? In her home, I have come to know her anxieties, priorities, and hopes for the future in a way that I wouldn’t have in the clinic. For many physicians, it is impractical to make house calls, so I appreciate the chance to do so. I get a glimpse of Mary in a place where she shines, among the things she holds most dear. If I met Mary in the clinic, it would be hard to see beyond the labels: “Wheelchair-using older adult with ovarian cancer, type 2 diabetes, osteoarthritis.…” In her home, I see her as she truly is. A former dancer. A devoted single parent. The matriarch of a large Southern family. I have learned her nonmedical history. She was born on a farm in segregated Virginia. The oldest of six children, she dropped out of school at 14 to raise her siblings after her mother’s death. Now in her 87th year, Mary has been dealt another huge loss. She has been diagnosed with Stage 4 ovarian cancer. It was caught only after it had spread to her right breast. She jokes, “This one wasn’t as flat as the other!” When we speak of her diagnosis, she cannot contain her anguish. “I feel I don’t have much time left,” she tells me. “There is not a moment that I don’t think about it.” Still, the cancer seems like a distant and elusive monster to battle. At present, she already has plenty to deal with. In a single year, she has withstood eight chemotherapy infusions, a life-threatening gastrointestinal bleed, and a long stay in the ICU over Christmas. She recently lost the ability to stand up on her own. One summer morning, she fell out of her wheelchair and spent a few hours lying on the floor until her son found her. This is what frightens her most—being helpless again. Until I met Mary, I never fully grasped the burdens of chronic illness—the way it fills a person with fear and exhaustion day after day. As she goes through this tumultuous period, I am glad to simply be present for her. Our conversations often return to the positive forces in her life. “What keeps me going is my family,” she says. “All those grands and great-grands, I see myself in them.” She tells me how grateful she is to be alive, to listen to Marvin Gaye as she did in concert back in her 20s, to see her grandchildren grow up with opportunities that America denied her. Mary has taught me about the practice of holistic medicine. She graciously lets me into her house and her life each week. I visit her not as a physician or an aide but as someone to offer support and an attentive ear. In the process, I have learned about her rich life history alongside her complex medical history. In the coming years, I hope to sustain the habits of curiosity and connection-seeking that I have practiced in her home. Shefali HegdeS. Hegde is a second-year medical student, University of Virginia School of Medicine, Charlottesville, Virginia; e-mail: [email protected]