We family physicians often toss around the phrase continuity of care almost as a badge of honour. In truth, it is a phrase that holds as much pain as it does pleasure.
Ninety and Up
I first met Madam T when she was seventy, attending for hypertension and diabetes, and once a year to put her thumbprint on a form authorizing me to make Medisave claims for her. She is now ninety.
The other day she came in on a wheelchair with her daughter. I had not seen her for some time. In the early days she would stride in on her own, a force of nature. Now she looked small and frail and a little lost, but she still seemed to recognize me.
As I reached for her hand to get her thumbprint, I asked her, How old are you this year? I am seventy, she replied. You must be quite hungry, I said, knowing she had fasted overnight to do her blood tests. Oh, not really, I’ve had breakfast. Her daughter shook her head and corrected her mother. At this point I told her daughter that I couldn’t take consent from her mum this year because she no longer understood what was going on anymore.
I felt quite sad. I guess it was because I have known her for twenty years now. The capable matriarch I once knew, who chain-smoked, laughed throatily, ate with gusto, and always found it a thrill each year to go through this ritual with me of withdrawing money from her Medisave account, no longer had the mental capacity to do that.
Commentary
A privilege that I cherish is the chance to follow-up with a patient for many years. With a young child, a young man or woman, I have the opportunity to watch them mature, go through their angsty, emotional years and emerge – one hopes – as happy, well adjusted adults. With an elderly person, there is poignancy as I watch them age, and in Shakespeare’s words, I witness the last scene of all that ends this strange, eventful history … second childishness and mere oblivion….. sans teeth, sans eyes, sans taste, sans everything.
The medical students have drawn a cheerful depiction of care from womb to tomb. The accompanying vignette is a less cheerful account of care nearer the tomb.
What of the doctor? Continuing care necessarily means that the doctor is growing older, tired, and more infirm too, as the patient grows increasingly frail. We grow weary together.
—- Dr Tan Su-Ming
Tan Su-Ming has been a general practitioner in solo practice in the heartlands for 25 years. She believes that if we knew everyone’s back story, we would be kind to everyone.
The vignette and commentary were reproduced with permission from the book ‘Being Human, Stories from Family Medicine’ edited by Cheong Pak Yean & Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
