It was a rather unlikely place to begin my clinical career.

Shortly after starting medical school, I signed up to volunteer in the hospice unit of my academic medical center.   The first few visits I relegated myself to fairly banal activities.  I shredded old medical records, or I might do a load of laundry for a family member who had been waiting tentatively by their loved one’s side and was unable to carry out such basic human necessities.  Over time, I became more familiar and would engage families, sit with the dying, and comfort the staff.  I once helped a nurse prepare a newly deceased body, and as we zipped the bag closed, she crouched into the corner and started to cry.

The act of caring for people in a medical setting was new to me.  Everything was fresh and pure.  I leaped at the chance to graduate from the hospice unit and tackle my first home patient.  Unfortunately, the day before my planned trip, he fell and was brought to the unit.  I visited him briefly before he died.  I even made a trip to the grocery store and bought a bottle of white wine for his last meal.

A few weeks later, another home patient requested a volunteer.  I walked through the brisk winter day down the city sidewalks, through the congestion, and stopped short of his building.

Ralph was an octogenarian dying of prostate cancer.  His wife had passed years before, and he had no children or close family.   His daily needs fell to a handful of caretakers who took shifts feeding and bathing him, arranging his personal affairs, and keeping him company.  I came on Thursday afternoons.  Usually, we would talk for an hour before he became tired.  Then as he settled in for a nap, I would run across the street and buy groceries to stock his pantry.

Sometimes we walked down the hallway towards the elevator.  He was a poet, and we talked above the rattle of his walker and tentative footsteps. My class schedule was brisk, and I had begun my clinical responsibilities.  I often imagined that medical education was somehow diminishing my humanity.  The thrash of knowledge and depersonalization of doctoring was smoothing out my rough edges, and making me bland and unpalatable.  But Ralph would trample me with his walker, replacing my rough edges by and by.

I woke up one morning to find that I could no longer hear his footsteps or that old creaky old walker.

Ralph died.

I still think of him from time to time, and marvel at how inspiring it felt to be engaged in the humble profession of taking care of each other.

Decades into my career as a physician, after all the hurt and pain I have been a part of, it devastates me that I no longer know how to get back there.

Again.

December 1996

Footsteps

Help often comes from those we least expect:

Sometimes your footsteps separate my dreams from reality as the echo of your walker disrupts the silence of an empty hallway.

I dream the great teachers of the world have taken me as their student. With sand paper, they smooth the rough edges but all the while I worry that in becoming soft and supple I will lose my character, my humanity. They give their knowledge freely but fight for it back with a vengeance. Your laughter distracts as you trample me with your walker, replacing my rough edges, and making me forfeit my strength by and by.

Recently, our walks are becoming shorter. You no longer have the energy to make it past the elevator, and after you want to lie down. As we pass our time together we watch our lives float by. Neither of us drowning but both frustrated by our lack of ability to control the direction in which the current leads. You, trapped in a body that can no longer house your vitality, and I sleep walking through a world of lost humanity.

I once dreamt that you were reaching out your hand to me. I was surprised to find that instead of needing help you just wanted to shake hands. But then, I was falling into a pit, and you were above me, my life line. But the expression on your face was undeniably saying good-bye. I woke up terrified to find that for the first time in months I can no longer hear your footsteps

I know now that you are free … and so am I.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician.