I Do Care

 Gustavo L. Franklin, MD, PhD at JAMA Neurology

I always strive to give attention to the patients I work with and seek to be kind and polite, even on the most difficult days for me. Like everyone, there are good days and bad days. I try to balance this with my family, and I always try not to get too involved, despite doing my best in my profession. However, today, in the last few minutes of a routine consultation, the husband of a patient with Alzheimer disease said to me that nobody cares. He said he tries not to care too, but he does care.

It startled me for a moment before he continued to say that each morning, he wakes up and doesn’t see his wife; he sees a child with a frightened look, a mere shadow of the person she once was, the one he loved, the one who raised their children. He gets up, speaks to her, but he is barely heard. Sometimes, he is not even remembered as she confuses him with someone else. When he feeds her, she dislikes the things she used to like. When he tells a joke, she no longer laughs. He shares all this with people, but nobody seems to care. When she does something wrong, he guides her; when she does something right, he praises her, but she seems not to care. He tells his family, and they say it’s the disease, there’s nothing to be done. It seems to him they don’t care either. He tells the physicians, and they say there’s no cure. He guesses they don’t care. The days go by, and they don’t get easier; they get harder. Much harder. He tries not to care, but he does care. He says she gave so much of herself to their family; she was the heart and soul. Today, the family doesn’t see her, doesn’t hear her, doesn’t feel her. Every night before going to sleep, he would kiss her and ask if she preferred the bathroom light on. He did that for 45 years, even knowing the answer, he asked every night. Tonight, when he goes to bed, whether he leaves it on or turns it off, it hardly matters. Sometimes he has moments of happiness when she remembers something or speaks as she used to, as if she were still his love. He confesses, it takes so little now to bring him joy. Other days, he says, he surrenders to despair. He says he tries not to care, but he does care. The other day, someone said to him that she will soon be gone. He spent a long two minutes trying to understand if that would be good or bad. Then they continued, saying that God knows what He’s doing. He says he tried to think of God, but he thinks He doesn’t care either....

When that gentle old man with a white beard finished pouring out his heart, I saw the significance of the physician facing the patient. The helplessness of patients and relatives in the face of insufficient medicine. Comfort may not be enough. From the height of the white coat’s sanctum and behind the marble of the desk that separated us, I could only remember Hippocrates’ phrase: “To cure when possible; to alleviate when necessary; to console always.” Then, I interrupted him: I care.

He cried. I cried.

Once again, I was reminded that we treat people, not diseases.

I confess. Sometimes, I try not to care.

But I do care.