Today I had a moment of sadness as I told a patient that I would be going on leave for five weeks. As I began to tell her my plans, her face fell and she said, "I'll miss you so much, but at least I'll see you in December." This woman and I have a close relationship bordering on what seems like a friendship, and the genuine warmth between us is a gift, as it is with a number of my patients. I also assumed that she could read between the lines, and that this leave of absence may be more than I was saying.
Why was I sad? Because this temporary goodbye is, by extension, practice for a larger, more permanent goodbye in the future. Whether I will take permanent leave of my job by the end of the year, or whether I tough it out for a few months in hopes of seeing some programmatic changes, this leave of absence which begins in ten days will be a taste of what it might feel like to really say goodbye.
There are patients who tell me they love me. There are patients, like the one mentioned above, with whom I have a great deal of warmth and positive mutual regard after more than five years of getting to know one another. Granted, the relationships are one way in most respects, but that does not decrease their true humanity and genuine quality.
Just this afternoon, I was visiting a patient who has not filled several of her prescriptions for more than a week---including her morphine---because she has absolutely no money left, not even enough for a $1 copayment. What could I say? How could I react? I dropped a twenty-dollar bill on the table as I left her mobile home. She took my hand and thanked me so graciously, her eyes sparkling with tears. How does one say goodbye to someone with whom one has been so connected?
Confusion, sadness and anticipation all coexist. Whether that coexistence is peacable remains to be seen.