A Medical Economics Web Exclusive

A token of gratitude I'll treasure always

Some gifts hold their meaning long after they've lost their usefulness, this author says.

By Sivaprasad D. Madduri, MD
Urologist/ Poplar Bluff, MO

"I bought something you've needed for a long time," my wife announced. "Where's your leather key holder?"

I reached into my pocket and handed it to her. She opened a plastic box, took out a new version of the old holder, and transferred all my keys. "You've been using this worn-out thing for years," she said. "You needed a new one."

She handed me the new holder, pitching the old one into the trash can.

When she left, I retrieved the old key chain and hid it in my desk drawer. There was a story behind that cracked and discolored leather holder—a story that I'd neglected to tell my wife. I still recall the day the Howards walked into my office.

They were an elderly couple, then in their late 70s. They'd been married for 49 years and had two children who lived in another state. Mr. Howard said his wife had been passing blood in her urine for a few months. He was worried that she might have cancer.

My workup confirmed his suspicions: Mrs. Howard had a bladder tumor. I scheduled a resection.

The afternoon following surgery, I told Mr. Howard that we were fortunate to have caught the tumor early and that his wife's prognosis appeared good. Of course, she would need to be cystoscoped periodically, but that was routine.

Mr. Howard placed an awkwardly gift-wrapped package in my hands. "This is for you, doctor," he said. "You've been so nice. This is a token of our appreciation."

I thanked him and carefully opened the package. There was a leather key chain purse. Could the poorly dressed Mr. Howard afford even this small present? With no insurance except standard Medicare, would the Howards end up paying a substantial deductible when Mrs. Howard left the hospital?

I released her the following morning. I saw the Howards waiting in the hospital lobby. They were waiting for a ride home from a friend, Mr. Howard said.

An hour later, they were still there. Their friend had not yet arrived.

"Couldn't you call a cab?" I asked. Embarrassed, Mr. Howard said he'd spent all his money to buy his wife's prescriptions.

Now I really felt guilty about accepting yesterday's gift. Despite his protests, I called a cab, paid the fare in advance, and sent the Howards on their way.

From that point on, John Howard and I had become good friends.

He'd discuss his personal life with me during his wife's office visits. Often, he talked about how much closer he and Mrs. Howard had become with the children out on their own. As I suspected, the couple squeaked by financially, living mainly on his meager Social Security check.

Following her three-month cystoscopy, Mrs. Howard needed to be readmitted to the hospital for a small recurrent tumor. It was a simple procedure, but I admitted her for overnight observation.

The next day I expected to see John. Instead, outside Mrs. Howard's room, I encountered several strangers. They introduced themselves as the Howards' neighbors.

John, they said, had passed away in his sleep the night before. Could I break the news to Mrs. Howard?

I conveyed the bad news as gently as I could, but my eyes welled up with tears and I had to walk briskly out of the room.

A few weeks later, the Howards' children stopped by to see me. Henceforth, Mrs. Howard would be living with one of them. I wished them good luck, and they thanked me for being a good doctor to their mom and a good friend to their father.

Mrs. Howard passed away six months later. She was never the same after her husband's death.

I now keep the key purse that John Howard gave me in my desk drawer. Each time I look at it, I see his face, a mixture of anxiety and gratitude. Although it's no longer used, I will treasure it forever.

Sivaprasad Madduri. A token of gratitude I'll treasure always.

Medical Economics

2002;24.