January 26, 2009 in Physician's Thoughts by rick

January 26, 2009

‚”Ellen, your cancer is in remission and you are feeling good‚Äù, I restated. ‚”Why don’t you do something nice for yourself? How ’bout a vacation? Is there any place that you’d like to see?‚Äù

‚”But who will look after Mother?‚Äù she shot back, more as a challenge than a question. In a long pause that followed, Ellen’s steely blue watery eyes looked deep inside me for the answer to the question that had evaded her for the last 50 of her 71 years.

She sat bolt upright, with a nice straight back, on the examination table awaiting my response. Her long salt and pepper hair was pulled neatly into a very tight bun which was enwrapped by a very tight thin braid. This architectural feat was held together by multiple bobbie pins jutting out at various angles. A starched lace bonnet was perched atop her neatly arranged hair, as if to catch any rogue nonconformist locks which would dare contemplate escaping. Equally severe and anachronistic was her manner of dress. She sported a fitted white shirt with a high-necked lace collar and long sleeves buttoned tightly at the hand. Whatever femininity was gained from her long lavender miniature floral print skirt was immediately lost by opaque orange tinted knee high nylons and black sensible shoes. I believe that this whole ensemble can be only purchased through the American Gothic Catalogue of 1872 for a sawbuck and three bits.

The only skin showing, aside from her long fingers that had clearly worked for living, was her face. Her pale skin, unwrinkled and unblemished, appeared almost as starched and tailored as rest of her. Between her long thin nose and prominent jaw line and chin pursed thin linear lips which struggle to contain of boastfulness of naturally straight large white teeth. Her intense blue eyes continuously shifted, never gazing, always seeking. And with a glower that would make any school librarian green with envy, Ellen sat opposite me, alone in the office at end of a difficult day, looking like I had just lost a hand of ‚”Old Maid.‚Äù

‚”Mother is 92 years old,‚Äù Ellen reminded me in her strong Pennsylvania Dutch accent, often emphasizing syllables and words in a manner different from conventional spoken English. ‚”She has a schedule that I have to keep.‚Äù

‚”What about placing her in a nursing facility for a short time?‚Äù I offered. No answer, just a glare. ‚”Have you considered a friend or relative to come in for a while or how about hiring a nurse for a few days?‚Äù

‚”There’s nobody else, and I am not made of money, you know.‚Äù

‚”I am sure there are others out there.‚Äù Why don’t you ask around? In the meantime, take this prescription.‚Äù I quickly scrawled, ‚”Have some fun‚Äù on the pad and handed her the top copy. Ellen strained to smile briefly.

Duty—that strong sense of commitment focuses our energy and skills towards completion of a goal. That goal may be caring for an aging parent, young child, sick spouse, or perhaps job related with evening meetings, weekend conferences, or holiday hours. In either case, duty is often tainted with a certain degree of self-denial. To complete our tasks, we freely give up our time and energy leaving little room for more seemingly pleasurable personal pursuits. And to what end? Why do we keep giving when there seems like there is nothing less to give?

Because, there is inherent value and worth in a job well done. Just the sense of being needed and contributing to something or someone is enough to keep us in the game. I cannot tell you the number of my own birthday parties I have missed due to being called to the emergency department or operating room to care for someone acutely sick to care for someone that I am uniquely qualified to help at that moment in time. A heart-felt thank you from the patient and her family overcomes my loss of personal time and hundred fold. It lightens my steps, elevates my mood, and fills my heart. After pulling into the garage at midnight, kissing my sleeping children and wife, I am filled with a deep sense of pride and accomplishment which is too great to describe.

I have thought about that office visit with Ellen many times and have since regretted giving her that prescription. My effort to lighten the mood and get Ellen to consider something for herself may have undervalued her strong sense of duty towards her mother. I am sure she experiences tremendous pleasure and reward from caring for her mother the woman who selflessly raised her for all those years. It is nice to be needed.

On the other hand, it wouldn’t be a federal crime if either one of us went to a neighborhood pub, knocked back a couple, and shot a game of pool.

She’d probably kick my butt.

Dr. Rick Boulay


Richard M. Boulay, MD, practices medicine in Allentown, Pennsylvania. He hopes practicing will someday pay off.