With my phone in hand, as I walk across the heated floors of the sauna, I see a message in caps lock. ON-CALL MESSAGE. FATHER OF AB. NEED DEATH CERTIFICATE. PRIMARY CARE PHYSICIAN: DR. CHU. My eyes scan again through the message: I had known Mr. B was in the hospital recently and we were supposed to see each other two days ago for a discharge follow-up, but he hadn't come. My fingertips numb and my ears ringing, I look up from the screen back to the scene around me. Women with cream bathrobes chatting softly, a pink crystal Himalayan salt lamp, and a stone water fountain bubbling, so evenly as to be a hum.
In the kitchen, several days later, my husband is stirring a pot of stew on the stove, the crisp winter sun shining through the kitchen window, and asks me what I think I'll do for the afternoon. "Something is on my mind; I think I'll write a little," I blurt out, right before my chest starts to heave and my breath starts to get heavy. Almost unsure of what is happening, I reach for him and when my face reaches his chest, I realize that his shirt is wet and I am, in fact, crying. I am ostensibly speaking to him between sobs, and I am telling him that my first primary care patient as an attending had passed. A young man with end-stage renal disease and a history of substance use, we had bonded over his love of fashion. On his first visit with me, he'd been wearing a vintage tan-and-black checkered peacoat for which he'd scoured the internet, eventually locating it through a retailer in London that had gotten through a boutique in Hungary. I didn't really understand the process, but I could tell it was something he was proud of. Over time we'd been working on getting his blood pressure under control and he'd been trying really hard to stick with his appointments and get everything aligned for a transplant.
Mr. B had a dog named Chubs whom I met once over a video visit. Mr. B was at the park that time and he petted Chubs under the chin over and over while we talked. A bright morning sun was shining from somewhere in front of him and it lit up his face while he chuckled about how worried he was when Chubs recently had a small bout of diarrhea. A few months later, at the very end of one of our visits, I asked about Chubs, and he told me that Chubs had passed. His eyes clouded over and he quickly looked away, but eyes toward the floor, he thanked me for asking before quickly gathering his belongings and leaving the room.
As I sit and write, I think about how Mr. B's death caught me so off-guard. As a junior attending, I'd spent so many hours anguishing over whether I was thinking of the right differential diagnoses or ordering the right workup but I'd never thought to prepare myself for when a patient of mine, a primary care patient, someone whom I had developed a relationship with over the last two years, would die. Or for that matter, for when this would inevitably happen, again and again, and again. Again and again, but each time with longer relationships, more tan-and-black checkered peacoats, and more dogs named Chubs. I had never stopped to think about what that might mean for me, a living and breathing person with the capacity and determination to care. As a primary care physician, I lived and breathed continuity, and somehow it hadn't registered that continuity, as much as I willed it, wouldn't continue forever.
It took that bright winter sun shining through that kitchen window, for me to somehow realize that underneath the surface, since that moment in the bathrobe with the stone water fountain bubbling in the background, I had been grieving. In this writing, in this statement, I am choosing to grieve. I am choosing to grieve and I am choosing to grieve openly and I am choosing to grieve deeply. I cared for Mr. B and I will remember him with the bright sun lighting up his face, the park behind him and a very content Chubs on his lap.
**All identifying information has been changed