Medicine from the heart . . . Katrina Austria, 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.

Family medicine resident Katrina Austria, MD, focuses on home visits with these reflections on the power of photographs.

Photographs

Photographs. Snapshots of life’s moments that people choose to hold onto. They are a reminder of how a person truly was when life was at its fullest. The moment is forever in the present, frozen in time. For me, photographs serve to remind me that my patient is a person, and exists in a special light for her or her family and friends.

During a day of home visits with a hospice nurse, I was welcomed into the homes of many hospice patients. These families were from many different socioeconomic levels, different walks of life, but each of the homes shared obvious similarities: the patient was always in his or her hospital bed in the center of the family room, surrounded by photographs on every wall, mantle, and in some cases, the ceiling. I found myself drawn to the photographs; I was challenged to match younger versions of the family members and caretakers in the room. I could not ignore the stark contrast of the hospice patient juxtaposed with vibrant versions of themselves.

                       “Do they find happiness when they see these pictures?” 
                       “Do they feel depressed, angry that they no longer look like the person in the photos?” 
                       “Can they still remember the moments captured in the photo?”
                       “Do they even recognize themselves in the photo?”

As a family medicine resident, I have the pleasure of having the ability to care for several members of the same family. I can appreciate the connections, the sources of stress and pleasure as I see my patients and their family members in clinic. Every day, I have to take into consideration working with the patient and his or her support network to find the best management. It is easy when you can see a person in his or her usual state of health, and at times with spouse or kids in tow. It becomes obvious that the patient has a life, and that others are connected and affected by this person’s health.

This support network is not always evident when you meet a patient in the hospital, when they might be at their sickest. Family members may have already left by the time you’ve arrived to admit them. It’s as if they were magically whisked into the emergency department from some nebulous place, and the thought of family does not come to mind right away. You tend to be more immediately focused on the chief complaint. You forget that a loved one may be worried at home because you’re trying to figure out how to safely replete the sodium. You just forget.

I had the pleasure of meeting Mrs. T during my hospice rotation. I did not meet her at first, but learned about her through a sit-down with her husband and eldest daughter. From this interaction, I pictured a weak pathetic elderly woman, dying from malignancy, who needed help with everything. But at least she had her family, right?

After the sit-down, we went to Mrs. T’s bedside. Indeed, she did appear small, weak and quiet compared to her family. It was almost as if she wasn’t aware of her prognosis. But truly, she was being stoic. She was aware of what was happening to her body, and the fear of what would happen to her family after she was gone was slowly building. Tears began to flow from her small timid eyes. Mrs. T had fought so hard to hide these tears. She knew that her family would be even more scared if she revealed her sadness. Everyone agreed that the most important thing was to make sure Mrs. T was comfortable through hospice care.

A few hours later, when Mrs. T was discharged home, I had the opportunity to observe a hospice home consult. I remembered Mr. T saying that his wife would be more comfortable at home. “She decorated everything to her style, in her colors. She would want to be home.” I drove to the family home and saw a familiar “No smoking, oxygen in use” sign on the front door and knew I was at the right place. I also noticed that the front door was totally painted in a Tiffany blue. My favorite color. “This must be her color as well,” I thought.

I was welcomed into the home by Mrs. T’s oldest daughter. Their home was lovely. Tiffany blue was evident in paintings, carpeting, and kitchen. I was secretly jealous of the decor! What I couldn’t help but notice were, once again, all the photographs on the walls and tables. The Mrs. T in the photos was a more robust, life-loving, smiling vibrant woman. I could hear her laughing, getting excited for parties, choosing a tie for her husband to match her own outfit. The photographs revealed a time when this family truly looked to Mrs. T as their pillar of strength. This is the Mrs. T that they still hold in their hearts, the Mrs. T they wish they could have forever. The family still had Mrs. T, and they would do all they could to keep her and honor her.

Experiences like these help me appreciate when loved ones choose to capture moments in photos. It is a reminder of how they wish their mother or brother could be. It reminds us as physicians that we are not only caring for the patient, but also for the people who hold the patient close in their hearts.