A Patient Who Became 'My Brother'

Most patients in my surgical practice I know for only a short period of time.

Some patients I take care of for a longer duration. Perhaps they did not get well following surgery and so I feel a sense of responsibility to oversee their care, referring them to, say a pain management physician hoping to get them some relief of their persisting symptoms. Occasionally, a patient will develop a surgical complication and I take care of them until the issue at hand is corrected or resolves.

Other patients actually over the course of time develop more than one problem for which they will return to see me.

Of those patients I take care of for an extended period of time I naturally develop a closer relationship with. Rarely, however do I develop a bond with a patient that transcends the usual doctor – patient relationship.

Robert Cross, however, was one of those patients with whom I developed a unique friendship.

Robert turned out to be one of those patients that failed to get better after the initial surgery I performed, requiring additional surgery. But he also developed a surgical complication requiring even more surgery; and then developed an unrelated problem requiring another (sixth) operation. Yet in spite of it all he was always grateful for what I tried to do to help him.

I first met Robert in December of 2002. He was 69 years old. He had previously undergone lower back surgery in April of that year by another surgeon and though his condition had improved he re-injured his back causing one of the discs in his lower back to re-herniate

So, on the 31^st of December I re-operated on Robert to remove the herniated disc that was pressing on his ‘sciatic nerve’ causing unrelenting pain in his left leg.

Following surgery he was certainly better, ‘but not 100%’. I then referred him to a pain management physician who performed periodic injections of cortisone in his lower spine to help alleviate his continued lower back pain.

Robert did reasonably well with this form a treatment for about two years. Ultimately the cortisone injections became less and less effective and then he developed recurring pain in both of his legs. Further tests revealed progressive degenerative changes and arthritis in his lumbar spine.

After reviewing the new MRI scan with Robert, I discussed with him the possibility of fusing his spine as I felt it might give him a degree of stability which I believed he was lacking with the advancing degeneration in his discs. He agreed and so on the 7^th of March 2006 I performed a spinal fusion on Robert Cross.

After he recovered from this surgery he was transferred to a rehabilitation facility but was readmitted one week later with severe left leg pain. Tests revealed it was only inflammation in the sciatic nerve and so I was able to treat it with medication.

Robert did well for about a year until the pain once again reoccurred, for which I performed two more surgeries. Unfortunately his continued complaints of pain finally led me to tell him, ‘Truthfully, there isn’t anything further I can do to help your back pain’. He nodded in agreement and thanked me for my honesty.

Later that year, 2007, Robert began having some difficulty walking but this problem appeared to be unrelated to his lower back. A CT scan of his head revealed that he had hydrocephalus so I inserted a ventricular shunt which improved his ability to walk somewhat. Unfortunately Robert also developed a severe peripheral neuropathy which caused his legs to feel constantly numb. As a result he was unable to appreciate where his legs were, particularly in a dark room, and this would cause him to fall frequently.

One day, not too long after I inserted Robert’s shunt I began to think of him more as a friend, and not a patient. I was in church and was returning from communion when I saw Robert sitting in a pew by the aisle. Without even thinking, I was drawn to him and I reached out my hand to him and extended a greeting of peace.

He was alone and I’m not sure he needed me to acknowledge him but I crossed the aisle shake his hand nonetheless. Actually, that meant a great deal more to him than I could have imagined. Several times after that day when I would see him he would remark about the event prominently, almost with a sense of gratitude, as if I lifted him from a moment of despair.

Actually, Robert had very good reason to be depressed. He was a very sick man, having multiple medical problems which over the ensuing three years caused him to be admitted to the hospital over 15 times; and during those hospital admissions he would undergo six more operations by two other surgeons! In addition, it was becoming increasingly difficult for his wife Joann to take care of him at home.

He wasn’t always admitted to Mease Dunedin, but when he was I would either find out he was there from Francy, my nurse or I would happen to stumble upon him making rounds on my surgical patients. Always I would stop by to at least say hello and to see how he was doing. And always he would turn to the other patient in the room if there was one and say, ‘This guy is a good man’. Slightly embarrassed I would say, ‘You are too kind’ and then reach out my hand to shake his, saying ‘It was good to see you brother’. ‘You too, brother’, he would reply.

Each time I saw him in the hospital he appeared to be getting weaker and weaker. Ultimately, because of his frequent illnesses, the amount of nursing care he required grew exponentially and so he had to move into a nursing home. The last time I saw Robert Cross in the hospital was in December of last year, 2010.

He had developed a pulmonary embolus or blood clots in his lungs. His spirits appeared good although he just seemed tired. I stopped by briefly to say hello, thinking I would stop back later in the week.

I never did see him again. He was discharged only to be readmitted on Christmas day at another hospital with pneumonia. Less than a month later he had a cardiac arrest and died, at 77 years of age.

A week or so later, his wife Joann called the office to let us know, and to ‘especially thank us for taking care of Robert over the years’.

Shortly after I felt compelled to write this story about him because, ‘He was a really good man’ and I wanted to ‘especially thank him for being my friend and ‘brother’ all those years.

Comments

[Kimberlec]

Very touching Hal.
It reminded me of the bonds/friendships I developed with a few the medical staff and home health care nurses who helped us throughout my mother's illness, maybe not as strong as yours and Robert's, but difficult to lose those relationships with the passing of the common denominator. Thank you for sharing your professional/personal experiences with us, it allows us to see that the medical side feels it too.
You are a good man Hal!

[Hal Colbassani, MD]

Thanks Kim. This story of course is illustrative of what I beleive to be true, that I can almost do more holding a patient's hand than using mine in surgery.
Peace,
Hal