"So," I said. "Thanks for coming in to see me. It's been a while."
"I'm happy to see you," he replies. "I'm glad you called."
I check his weight, his vital signs, feel his belly, listen to his lungs, review his last labs.
"You know, I'm worried about my liver. I haven't been to the specialist for a long time."
"I've been traumatized by the whole idea that the cirrhosis is turning into cancer."
"Wouldn't you feel less afraid and anxious if you had more information and saw the doctor?" I ask.
"No. Sometimes it's better just to not know anything." I think he's serious.
"You mean," I reply, "like what you don't know won't hurt you?"
"Yeah. Like that," he nods.
"Hmmm." I look at him and move my rolling stool closer to his chair. "I always think that information gives you the option of acting or not. Otherwise, you're just blind with fear and anxiety."
"Am I gonna die?" he asks me plaintively. "Can my cirrhosis be cancer now?"
"Well," I choose my words carefully and slowly. "Cirrhosis can lead to cancer if you're not careful. If you're drinking alcohol, it's like pouring gasoline on a fire."
We look at each other silently for thirty seconds or so.
"Tell you what," I say. "I'll call the liver specialist and see if he has an appointment open on a day when I can accompany you. Would it help you feel less anxious if I went with you to the appointment?"
"Are you kidding?" He stands up and offers his hand for me to shake. "That would be so helpful. You can do that?"
"We can do whatever we want," I reply. "I'll call tomorrow and make an appointment for next month before my vacation. Meanwhile, you take good care of yourself and come back and see your primary doctor on June 1st. I'll see you then, OK?"
"Alright," he replies. "That sounds great. I feel much better now."
"I'm so glad. Will you call me if you need me?" I hand him my card.
He accepts the business card and says, "I always lose your card. I'll put it in my wallet now." He tucks it into his leather wallet which he pulls from his back pocket.
"OK. See you on the 1st of June. My office will call and remind you of the appointment. And don't worry."
We shake hands. I pat him on his shoulder as he steps ahead of me and walks towards the exit. We've had similar conversations in the past. He's even put my card in his wallet at least three or four times before. Is this time different? Will he follow through after having been lost to care before? Hard to say. But each time we have contact, we're building trust, constructing a relationship, and moving towards a goal of empowerment and therapeutic partnership. Maybe he'll no-show on the 1st. Maybe he'll no-show to the gastroenterologist. But he showed up today. And for now, that's good enough for me.