I had been attending this particular patient's medical needs as her general practitioner for the past five years. Enid dressed impeccably, was a young 85 years of age and had the amenities that most elders dream about. She had her health, financial security, education and a strong intellect. What she was missing was companionship.
"If only I had someone to travel with," she lamented.
Hardly 24 hours later, I was asked to see Fred, who had been my patient for seven years. He was a robust 87-year-old, financially secure and well-educated and possessed a marvellous sense of humour. He had remained active despite having lost his partner to lung cancer the year before.
"I miss having someone when I travel," he told me.
Hearing these patients express an identical desire within 24 hours had an odd effect on me. I sensed that the boundary to which I had steadfastly adhered for the past 25 years was somehow null and void in this particular instance. Awkward as it was, introducing these patients to one another seemed at once appropriate and sound care for both. They matched on so many levels.
My next words surprised Fred and even startled me. "You're not going to believe this," I began, "but not 24 hours ago I saw another patient in this very room wishing for a travel companion as well."
These words sparked a sense of uncertainty, but hope – even excitement – within me. Introducing patents is ethically questionable and does not fall within the expected boundary of a physician/patient relationship. On the other hand, what better medicine for loneliness than companionship? This prescription seemed nothing short of patently obvious.
Within a few minutes, Fred gave me permission to provide his name and telephone number to Enid. My own hesitation notwithstanding, I gave her a call and described him to her. She was cautious but agreed to his telephoning her.
Two months went by before I saw Fred again.
"I know you're curious," he grinned. "Enid and I are talking every day and we go out for coffee. I must thank you. She's really quite a nice lady."
Two weeks later, Enid expressed a similar sentiment about her new-found relationship with Fred.
"Such a gentleman, he's truly quite wonderful," she said.
Over the following year, their relationship steadily strengthened. They enjoyed long walks, went to the theatre, shared intimate dinners and took the occasional local trip together.
Fred was 90 years old when he was diagnosed with lung cancer. He and Enid continued to share daily conversations throughout his chemotherapy. On several occasions, he expressed gratitude for the companionship that they continued to share. Although he greatly loved his immediate family, he repeatedly said children and grandchildren could never offer the same validation and companionship.
Notwithstanding his illness, Enid told me that she, too, was grateful for the new relationship. She looked forward to their daily calls and they continued to meet for coffee when his health allowed. Their bond had blossomed into a meaningful connection that sustained him even as he entered palliative care.
Well before these encounters, the tremendous healing of meaningful companionship had delighted me. It has also saved my patients from tests, drugs and referrals. It has long been known that more socially isolated individuals are less psychologically and physically healthy and are more likely to die sooner. Yet, while beautiful and seemingly simple, this is all too scarce, especially in the twilight of life, as Fred and Enid had been.
Introducing two patients is a foray into the murky realm of the art of medicine and is highly exceptional. In 25 years as a family physician, I had never before and never since introduced two patients. Even thinking this way is counter to my training. As physicians, we are taught to offer a sympathetic ear and an investigative workup and to prescribe medication to ease emotional pain. We are taught to remain impassive, to sit on the sidelines of loneliness and to simply reflect on emotions.
In this instance, the introduction was highly therapeutic and proved beneficial to both.
Should a physician contemplate such a role? Is there any instance in which such an introduction would be desirable or even ethically called for? Would you personally agree to being assessed by a physician who would consider such an introduction?
At one time, I would have responded to these questions confidently and without hesitation: To take on such a role is perilous to both patient and physician. Patients are vulnerable. No health-care worker can fully understand what is truly in the heart of a patient. Emotions are complex. A patient may misrepresent feelings or may reinvent individual reality. Fears may be expressed as facts. Good intentions and strong intuitive senses on a doctor's part are subjective and may be misguided.
But physicians are also taught to understand that the rare exists, to never say never. We are taught to understand that strict rules that invoke the term "always" in medicine do not exist. Exceptions to the norm are ever-present. It is how such exceptions are managed that the practice of medicine transforms into the art of medicine.
Iris Gorfinkel is a family physician in Toronto.