Page 5 - Mecklenburg_Medicine_June-2018
P. 5

A Love Story                                                                                President’s Letter

By Scott L. Furney, MD                                                  In the two years (or so) I cared for him, we avoided the ED, the
                                                                      hospital and all of the other things we usually see at the end of life.
A patient of mine passed away a few months ago.                       His case has crystallized for me the true meaning of value-based
                As I reflect on his life story and passing, the       care. Not in the Medicare “spend per beneficiary” way insurers see it,
                privilege our profession provides humbles me.         but in meeting goals for his life with dignity, grace and comfort.
                We engage in the improvement, extension and
dignity of our patients’ lives.                                         We have the profound privilege of seeing into the most private and
                                                                      vulnerable parts of our patients’ lives. In that space, we bring value by
  He came to me as a complex patient, who had clear goals             helping patients achieve their goals, even if not the traditional ones we are
for the remainder of his life. Although he was ill, he needed to      taught in medical school. The real value is to us, though, if we take the
be around to care for his wife of more than 60 years. She was         time to appreciate the privilege we are given and rejoice in our efforts.
disabled and no longer could live independently, so his existence
primarily was to spend time with her in her nursing facility. He        To some it may seem I sacrificed a lot to care for this man
joined her for at least two of her three meals, going back to his     (and his family), but I received so much more in return. The
own apartment briefly, if at all. He returned to his apartment at     Friday evening visits still nourish my soul as I reflect on what
night when he knew she was settled in and was as comfortable          our profession means.
as her conditions would allow. That love and devotion kept him
going, even when he was quite ill.                                      In humble service,

  I was asked to see him by his daughter, who was struggling             CHARLOTTE AHEC COURSE OFFERINGS
to find someone to help with his care. He had advanced kidney
disease but did not want dialysis, as he had seen its effect on                Charlotte AHEC is part of the N.C. Area Health Education Centers
the quality of life in others. After declining dialysis, he said his                 (AHEC) Program and Carolinas HealthCare System.
physicians did not feel they had anything left to offer him. That
alone could be a topic for an article, but not today.                 JUNE 2018
                                                                      Continuing Medical Education (CME)
  While I will not detail much of his medical history, suffice it to
say he required a great deal of “adjustment” to keep his diseases     	 6/4	 Hello: Making Tough Conversations Easier
at bay. I had him come to my office for the first few months until    	 6/5	 Aligned Together to Realize, Innovate, Unite and Motivate
I realized travel was quite a burden for him. Then I began making     		 Antimicrobial Stewardship Programs
home visits. My visits were monthly at first (aided by Hospice        	 Online	 Risk Management: Patient Identification
nurses who checked frequently), and with increasing frequency         	 Online	 Social Media: Risks and Benefits for Physicians
over a year’s time. Eventually, it was my Friday afternoon routine    	 Online	 Prevention and Management of Concussion/Mild Traumatic
to see him on my way home, just a few minutes detour from my          		 Brain Injury
usual route. I found myself spending more and more time with          	 Online	 Motor Vehicle Crash Victims
him, but not always out of medical necessity. I truly enjoyed his     	 Online	 MTAC Trauma Modules
company and the gruff wisdom he shared.                               	 Online	 Get the 4-1-1: Everything Primary Care Providers Should
                                                                      		 Know About Parent Training in Behavior Therapy While
  With little warning, his wife became gravely ill and passed         		 Working With Families With Young Children With ADHD
a few days later. While he and his family grieved, very little        	 Online	 Electronic Medical Record on Trial (Risk Management)
else changed for a few weeks. Then I noticed it ... the spark
of purpose had left him. Fatigue, edema, insomnia and other                For more information or to register for these courses, call 704-512-6523
symptoms appeared. I checked his renal function, which had                                      or visit
been amazingly stable for two years, and found his creatinine
nearly had doubled. It was as if his kidneys realized they had
met the last major goal in their host’s life. I had seen Takasubo
cardiomyopathy (broken heart syndrome) but had not seen
“broken” kidneys before.

  Over the next few months we worked diligently to maintain his
dignity and independence. When the number of good days were
outnumbered by the bad days, he requested we stop his complex
pharmacologic regimen and let nature take its course. His final
goal was to stay in his home, while approaching a dignified death.
We were able to achieve that goal with loving family support, a
little advice from me and fabulous Hospice nursing.

                                                                      Mecklenburg Medicine • June 2018 | 5
   1   2   3   4   5   6   7   8   9   10