Monday, October 4, 2021


She was 19, here for migraines. She was nervous, had never been to a neurologist before, and her mother was along for emotional support.

We talked a bit, went over some treatment options. Nothing too costly. She worked full-time as a waitress, trying to save money so she could start college soon. We settled on nortriptyline and naproxen, and I began writing out scripts.

As I scribbled, I blinked.

Suddenly the scripts were gone. Instead of paper, I was typing in an online refill for generic sumatriptan… which a minute ago was brand-name, and she couldn’t afford it.

She was still there, across my desk, but she’d changed, too. She wasn’t a waitress anymore. She was working full time as a nurse, was married, and had two daughters. I remembered her having moved away to go to college, then nursing school, then coming back here. I recalled her telling me she'd gotten engaged. I’d treated her migraines through both pregnancies.

The nortriptyline hadn’t helped, and now she was on Aimovig, a drug I hadn’t imagined when she first came to me. In the time between then and now, besides the times she lived out-of-state, I recalled trying a handful of different medications over the years.

During my blink she’d developed a few gray hairs, wrinkles, and pounds from the stresses of daily life, jobs, raising a family, and making ends meet. I’m sure mine are worse.

This is also part of medicine, just as it is in everyday life. Over our careers we see college students mature into adults with jobs and families. We see parents become grandparents. The middle-aged become elderly.

We see people we’ve grown to care about die of things we can’t fix.

Being a doctor reflects the changes we see in our own lives as we travel around the sun. Our patients become a sort of extended family. We aren’t directly involved with their daily events, but we catch up on them here and there, and they see the same changes in us.

The drawings my kids did are still on my office walls, but haven’t been updated in a long time. Picking them up from the after-school program has been replaced by picking them up from the airport.

My hair has gradually thinned over time and become grayer.

The glasses I’ve worn since I was 8 have become bifocals.

All in a blink.


LadyJane said...
This comment has been removed by the author.
KJL said...

How very poignant. I'm retiring next month and having been thinking similar thoughts. The practice of medicine has changed so much, but the art of medicine lives on.

Suzan said...

Yes I understand. My doctor has been my general practitioner for just over 40 years. He has walked with me along the way. He cares for two of my children. I appreciate all he has done for our family. Sadly the poor man had a huge fall last week and it brings to mind that he won't be my doctor forever.

Anonymous said...

So true - I see it at the pharmacy every day and in my kids. Getting old is for the birds.

Pharm.Tech RDC-08

Anonymous said...

Funny, I know my kids are all about to finish high school, but every time I look at them all I see are pigtails and mischievous smiles of 4 year olds. The days too long, the years too short.

Anonymous said...

Second Law of Thermodynamics. Inevitable, unpleasant and an unavoidable fact of life.

HeroHog said...

Bless you for your long and dedicated career as well as your much appreciated humor!

A. Marie said...

Dr. G, this post moved me to tears; it's a doctor's version of "Sunrise, Sunset." And as the spouse of a man with rapidly advancing early-onset Alzheimer's who's now in a nursing home, I find myself humming a slightly revised line from the M*A*S*H theme as I walk out the door: "The game of life is hard to play/We're gonna lose it anyway..."

Don McCollor said...

(Don McCollor)...Our local funeral director (undertaker) died a few years ago. He had buried my parents, grandparents, relatives, and friends. It was sad, because I thought he would be the very last to let me down...

Anonymous said...

Wow. Just wow.

Packer said...

I can add nothing except to say we need more clear expressions of love for each other. This is one such.TY

Anonymous said...

I'm a veterinarian, a little over 20 years in practice. I've seen my clients through their pets' old age and death, helped them raise their next puppy or kitten and seen them through that one's death and now into the third generation of pets. It's an honor to me that I can talk with a client about their pet from 2 generations ago - I'm doing something right that they continue to trust me for that long. With all the COVID demands on a vet's time these days (we're WAY more busy than we were in 2019) and the increased crabbiness of everybody, I'd lost track of that. Thanks for the reminder of the positives of my career.

Rain said...

The circle game. "We're captive on the carousel of time
We can't return, we can only look behind from where we came
and go round and round and round, in the circle game.".

My elderly parents recently told me they talked to a funeral home director and I won't have anything to worry about when they pass, it is taken care of. The funeral home is one that has been in my hometown for as long as I can remember, but now the owners have changed. It is now owned by the son of the original owner. I graduated from high school with the son. He is now a middle aged man.

My son is in his 2nd year of college. I have an AARP membership.


Unknown said...

This says it all:

gloriap said...

The sands run through the hourglass whether we like it or not. The tragedy is that so few people have both the time and resources to live their dream lives and become old and infirm thinking "I wish we had...."

Linda Myers said...

What a fabulous post! On a one-off note, my son grew up in our family home. Last summer we remodeled our daylight basement into an apartment for me and my husband so we have no stairs. Last month my son moved in upstairs. He's 42 now, and I am having a hard time remembering he's all grown up and doesn't need reminders from me!

Shash said...

And that's exactly how it happens. Amazing things, life and time.

dj said...

Great post. So true.

Anonymous said...

I saw a patient with vague back pain. As an orthopaedic surgeon, I suppose I should not have cared much.
But I had known him for years for small problems and from him bringing in his mom.
He looked like crap, not well.
I told him I was worried about him, sent his to GI doc I knew well.
He scanned him, full of cancer, dead in 6 weeks.
All is temporary, there is no permanent.
I am satisfied that he had time to prepare, that is all I could have done. He was a nice farmer, kind to his livestock.
Knowing your patients makes for better care.

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