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Memories of Lew

Bob RaunerBob Rauner

All of us have patients in our practice that we look back on from time to time.  They are often patients that we enjoyed taking care of and miss seeing.  Recently I happened to pass the wife of a former patient and was flooded by memories of her husband Lew.

I started seeing Lew after his previous physician retired due to health problems.  Lew had been having problems with a chronic cough that had not responded to inhalers that had been prescribed by his previous physician.  His exam was unremarkable except for his lower eyelids, which seemed to be edematous and full of clear fluid. I told Lew that there were many causes for chronic coughs, and that we should first start with the most common causes. I thought allergies would be high on the list due to his edematous lower eyelids.Unfortunately, he didn’t improve despite several medications for allergies. We then proceed down the list of causes, trying antacids and asthma medications.

I had little success so I sent him to the visiting ENT who again tried allergy medications and antacids without success.  We next tried the cardiologist and made little progress.  The pulmonologist also met with little success until he ordered a CT scan of Lew’s chest. Unfortunately we discovered an adenocarcinoma in his mediastinum.

Lew and his wife accepted the diagnosis as well as could be expected of any couple.  Treatment from the oncologist showed little benefit, and Lew and his wife accepted that his disease was most likely terminal. Despite his cancer, Lew still felt reasonably well and I encouraged them to try to enjoy the time they had left.

Lew continued to come into the office fairly regularly. His complaints were usually minimal and more than anything we would just talk for a few minutes. I have a habit of looking ahead at my schedule for the week during down times and the sight of Lew’s name on the appointment list usually brightened my day. I looked forward to seeing him and I admired how he and his wife seemed to be adjusting to his disease.

Unfortunately, the cancer caught up to Lew after about 8 months. He then deteriorated more quickly than I had expected. Fortunately, this meant he suffered very little and we were able to keep him fairly comfortable to the end. I didn’t go to his funeral. I have yet to go to any of my patient’s funerals. I think this has something to do with my struggle of trying to care for my patients, yet still maintain some distance in order to maintain my sanity.

I practice in my hometown of about 6,000 people. One of the quirks of practicing in a small town is that you regularly see your patients and their families outside of the office. I occasionally see Lew’s wife—at the café, on the bike path, at the Dairy Queen, etc. Each time I remember Lew and I can almost see him standing next to her.

As physicians, it is very hard to maintain that balance between caring for our patients and at the same time maintaining our sturdy “I can handle anything” exteriors.  Unfortunately we receive very little training on how to do this in medical school and residency. I seem to be getting better at it, but it still catches up to me from time to time.

Bob Rauner, MD

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