Loss is something all humans face in their everyday lives.  As a physician, the effects are often magnified.  People die, they move away, they graduate from your services, or occasionally they pursue care elsewhere.  Parting can sometimes bring relief, and others a deep sense of failure.  But with Clara, I’m not sure we actually parted.  Mostly, I was left with confusion.

Clara came to me by way of the nursing home.  Her family had brought her to the hospital when she became too weak to rise out of the reclining chair in her living room.  The hospital stay was short.  Multiple diagnoses were made: dehydration, deconditioning, and a urinary tract infection.  Her transfer to the skilled nursing facility was meant to give a few weeks of therapy to gather strength.

I came to see her from time to time.  Clara liked the personal interaction of the therapy room, but her daughter was unhappy with the pace of improvement.  We had a family meeting and adjusted the treatment plan accordingly.  I explained that Clara was well into her nineties, and sometimes improvement was not as fast or complete as we wish.  Her daughter heard my words but seemed reluctant to agree with such uncertainty.  She was sure her mother just needed more pushing.

One night, I got a call from the nurse on duty informing me that Clara had fallen;  I came early the next morning to evaluate.  The staff had reported no pain at the time, but when I entered her room I knew immediately that the hip was broken.  Her lower extremity was deformed and rotated inward.  We called an ambulance, and she was taken to the hospital.

I visited Clara every day.  I discussed with her surgeon and family the prognosis.  The operation was a success, although Clara developed an infection and had to stay a few days in the intensive care unit.  Eventually, I wrote the order to transfer her back to the nursing home.

The head of nursing called later that day to tell me that Clara had decided to switch physicians.  Since we had formed what I thought was a strong doctor-patient bond, I took the news poorly.  A few days later she wheeled into me while I was leaving another patient’s room.  She apologized that her daughter had demanded that she change physicians and hoped I would continue to stop by and see her socially.

Over the next few months, I interacted with Clara more than ever.  She searched me out at the nursing home and showed off her progress each time.  First she was able to stand.  Then walk.  Finally, she was chasing me up the stairs.

And I marvel now at how once again I lost a patient, and yet this time gained a friend.

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. He is the author of I Am Your Doctor: and This Is My Humble Opinion.