The following post appeared in my blog on 8/29/06

Warning! Those of you expecting a goofy and silly post, this is not one (in fact it is quite serious).

My nurse cried.

He was one of our favorite patients. He missed his appointment today, and since that was not his nature, I called to see what was up. I got his son on the phone who told me, "He's dead. He shot himself on Sunday." I couldn't believe it and confirmed that this was, in fact, the right number. He left a note saying he was tired of being sick all of the time and he was sorry to do it this way.

The thing is, he would have been one of the last patients I would expect to do something like this. He was in his 70's and had been fairly sick over the past week, but I was doing what I could to get him better. He had multiple long-term illnesses, including diabetes, but they were generally well-controlled. He was very fond of me and especially my nurse. He seemed to truly enjoy talking and would make me laugh with some wry comment when he came in.

We first won him over when he transferred care from another doctor. He was surprised at how aggressively we went after his diabetes, but felt so much better for it that I had won a lifelong patient. Then we were able to get him his medications for free through patient assistance programs. After that, he started sending his friends (mostly women) to me to be their doctor. He was well-loved by the ladies, but not in a sensual way - they seemed to have a genuine affection for him. That affection is what we too felt for him.

He spoke slowly and with a gentleman's southern drawl. He was known to my staff by his first name, and he was one of those patients I was always happy to see. He gave us absolutely no warning about what was going on inside of his head. When I saw him last week I was concerned about his health, but he never told me how he was feeling.

This abrupt ending makes me take stock of my actions. I do my best to spend enough time with my patients, but tend to get behind and have to hurry to not get any later. I try to listen to what they are really saying (as the famous saying among doctors goes: the patient will always tell you what is wrong with them - you just need to listen to what they are really saying). I try to practice by that rule and listen to what they are really trying to tell me. Yet I get caught up in the rush, the phone calls, the drug-seeking patients, the anxious mothers, and the pile of forms that I have put off filling out. I am trying to manage their diseases by evidence - getting their numbers just right and making sure they have gone to the right specialists. That's good care, right?

There are other distractions too. I spend (too much) time blogging and reading blogs. I go around giving talks to doctors about computers. I am the senior partner of a business, so we have all of the financial headaches to worry about. Dare I leave out the fact that I have a wife and four kids at home who need me? Life is busy. Life is busy.

So what does it mean in this context that I laid my hands on a man who later in the week committed suicide? I was one of the last people to physically touch him while he was alive. Did I miss anything? I don't really think so. He wouldn't have wanted me to worry about him. But I am glad for all of the time I did spend with him. I am glad that I got to enjoy him as a person for the time he was on this earth. I am glad I was one of the good things in his life. I am strangely glad that I knew him enough to be so saddened by his abrupt end.

There will be no funeral. There will be no good-bye. We just have the memory of this gentle southern man who kept it all inside. Maybe I could have done differently, but I won't go there. I can't go there and keep from going crazy. I got to add more to his life than most did. I need to carry that fact into the exam room tomorrow when I see other patients. Yes, there is a lot to do. But there is really no greater honor to be allowed to serve these people. I can't forget that. We all can't forget that.

Good-bye, Jimmy. Thanks.