A Medical Economics Web Exclusive

Why I sent flowers to a biker

A fearsome patient taught this young physician how to focus on what’s really important.

By Debbie Heck, MD
Family Physician/Muncie, IN

John was a biker with a reputation as a mean, hard-drinking character, kind of a Hells Angel without the gang. A serious motorcycle accident 30 years before I met him had left him with a badly injured, shortened leg.

While I was never quite sure how he’d earned his living when he’d still been able to work, I did learn that he had at least seven siblings, a mother, and an on-off relationship with a woman. John would remain somewhat of a mystery during our six-year relationship.

At the indigent clinic where I worked when I was a resident, he would sit down next to me. His 260-pound frame appeared even more formidable close up. Sometimes shaven, sometimes not, he would begin his litany of physical frailties. Once I convinced him that we could focus only on the most important complaint at each visit, we got along fine.

While ignoring him would have been difficult, giving up on him and his concerns would have been easy. His blood sugar kept rising, but what else could he expect if he kept on drinking? Still, I didn’t give up.

Over time, he began to trust me. He knew I wouldn’t ignore him, and he learned I wouldn’t let him take advantage of me. Antidepressants began to enable him to modify his behavior. And an occasional dose of anti-anxiety medication was preferable to a bottle of booze to calm his anxiety.

When he began to complain of swallowing problems, I knew it wasn’t a ploy for attention. His unique esophageal dysmotility problem ended up as the topic for a residency conference by the gastroenterologist I referred him to.

Following my residency, I worked in an urgent care center. Though I lost direct contact with John, I kept up on him through his sister, who continued as my patient. When she told me he’d started drinking again, we shared our concerns.

Making a rather grand entrance, he appeared at the urgent care center a few weeks later, his booming voice attracting the attention of staff and patients. He’d come to have his blood pressure checked and to see "Dr. Debbie." I don’t recall what his medical need was that day, but he was glad to see me again–and I was sincerely pleased to have him there. John was a rough character, but he had an engaging sincerity about him.

All went well until I asked him how much he was drinking. "Why, I haven’t had a drink in at least six weeks," he insisted.

"That’s not what your sister tells me," I replied.

With this, he drew up his large frame, extended an accusatory index finger toward me, and declared she was a "goddamn liar." My assistant plastered herself protectively against the wall.

He then sat down, apologized for his behavior, and left. Over the next few months, he’d come in to have his blood pressure checked, but mostly he just needed to say Hi.

As Christmas neared, John began looking jaundiced. He’d lost at least 20 pounds. Subsequent exams by specialists confirmed he had lymphoma. Within days, he developed pneumonia and ended up in the ICU on a ventilator. No one expected him to make it out, but he did.

Following his release from the hospital, he came to see me every week or so, even though I wasn’t really managing his care. I was someone he trusted, someone who would listen to his questions. It didn’t really matter whether I had the answers. He’d also bring his mother to see me when her bronchitis acted up, always assuring me that their bills would get paid, which they did.

During the next few months, his mental status deteriorated. While hospitalized in June, his family convinced the admitting doctor he needed psychiatric care. Medications allowed him to become calm, lucid, and generally appropriate.

One Saturday in late September, John’s sister came to see me. She was quite stressed. John had been living with her for a few months and now required nearly constant care as he grew worse each day. I assured her I would visit him on Monday. "If he knows you’re coming, I know he’ll hang on until you get there," she told me. I ordered a bright bouquet of flowers to be delivered to his home.

Late Monday morning, another former clinic staff member and I went to see him. John was now a jaundiced skeleton of his once husky self, so weak and in pain that he could barely move his arms. On seeing us, tears formed in his eyes. We sat together for several minutes with little to say but much to be felt.

"I don’t want you to send flowers after I’m gone," he said.

"I know, John. That’s why I sent them today."

"I have so many questions," he said feebly.

"And it won’t be long until you have all the answers," I replied. "Will you please tell the Lord I said Hi when you get to meet Him?"

Within hours, John slipped into a coma, and he died that night at age 58. It seemed he had waited for me. If I hadn’t taken that short time to visit him, I would have let down someone who had come to trust me at my word.

Since my first day of medical school, I have cherished the story of the boy who throws the starfish back into the sea. Many starfish wash up on shore and you can’t toss them all back. But the ones you do may survive. I’ve always embraced this story as my model for practicing medicine. No, I can’t save all my patients, but I can touch and save many.

While the money of medicine may provide the outward symbols of success, it’s the ministry opportunity of medicine that ultimately makes it the most satisfying way I could spend my work life.

John, many lives have been enriched because you were with us.

The author can be contacted at DocDebbee@yahoo.com.

Debbie Heck. Why I sent flowers to a biker.

Medical Economics

2001;7.