For these patients, I'd work for free

It has been said that one of the reasons that doctors' incomes and political clout have suffered over the past 50 years is that our predecessors-and now our generation of physicians-have been spending so much time taking care of patients that we failed to pay attention to what was happening to us.

My father, now 91, was a surgeon who started practice after World War II, and I know for a fact that he paid almost no attention to what he was earning. His focus was on his patients. I believe I first heard the comment "This is so great, I would do it for free" from him, but I heard it said many times during medical school and residency.

In practice now for 25 years, I'm glad I have in fact been paid and paid well for my work. Still, there are a few patients who come along and give us much more gratification and satisfaction than a paycheck ever could.

He thanks me . . .

Henry Charleston, who's now 82, married Marion, his high school sweetheart, the day after they graduated. Together they raised six children, have 15 grandchildren, and recently had their first great-grandchild. About six years ago Marion began to manifest signs of dementia, and for the last three years she's been incontinent, nonverbal, and requires round-the-clock care. Henry has chosen to keep her at home and has been Marion's full-time caregiver.

Ever since the Charlestons joined our practice several years ago, I see them every month to check on Marion, and, frankly even more, to check on Henry. I want to make certain he can still handle this very challenging job he has so freely chosen. At each visit I examine Marion, tell Henry what a great job he's doing, and remind him to get enough rest and to ask his kids for help. He watches me carefully as I examine his wife, fully understanding that we can't reverse or even meaningfully modify her dementia, but wanting to make certain that he's doing everything he can for her.

Henry doesn't say much when I tell him what a great job he's doing, only replying, "She's my wife, Dr. Waltman. It's not a job. It's what I want to do." Sometimes he will add, "She'd do the same thing for me."

Every time I see the Charlestons I have strong feelings of sadness and of joy. Sadness for this terrible illness that has robbed them of so many happy years together. Joy for this remarkable love story. The joy outweighs the sorrow, and I always feel enriched and invigorated after I see them.

At their last visit, Henry shook my hand firmly and said, "Doc, you've done so much for us. I can't thank you enough."

You already have, Henry. You already have.

I keep trying . . .

David Robinson has been my patient for more than 12 years. When I first saw him he was 46-years-old, weighed 285 pounds, had a blood sugar of 275, cholesterol over 300, and very poorly controlled blood pressure. I was determined to aggressively address his excess cardiovascular risk and make him well.

Our successes have been few and far between. At his last visit, Dave weighed 287 pounds, still had high blood pressure, and his blood sugar and cholesterol levels were only moderately reduced. The numbers would be better if he took his medications regularly, but he doesn't. That's been a big source of frustration for me over the years.