Thursday, August 11, 2011

The same look

It's been a hectic few weeks, with no time to even think about blogging.  But, we've closed on our new house, I'm finally transitioning over work projects here, and the Singing Pen is glad to be back at the keyboard.

I spent most of my free time last week addressing letters to my patients that announce my out-of-state move and imminent departure.  I handwrote every name in the "Dear" line and signed each one individually, so it took a while.  I recognize that I performed this act entirely for myself; it was my opportunity to pause and reflect, if even for just a moment, about my relationship with each patient and family.

But the letters are starting to arrive at homes, and my patients are starting to arrive for their final appointments to say goodbye.  I care for a diverse group - poor urban dwellers and university professors, young transplants to the area and four generation families, white and African American and Iraqi and Vietnamese.  Yet, despite their many differences, each of my patients has been wearing the same expression when our eyes first meet for these appointments.

Their chins point toward the ground, slightly, and their eyes look up at me, daring me to confirm the letters' truth.  Accusations of abandonment are clearly evident in their wrinkled foreheads, and their downturned lower lips hint at the sadness of a severed bond.  The slight pinch of their noses display unease, perhaps, with the unknown regarding their next doctor.  They offer no words to me, waiting instead for me to speak first.

"So you got my letter," I usually say.  I reassure them about their new family doctor here and share my joy in our relationship and sadness in leaving.  They wish me well and thank me for my care over the years.  On and on these encounters repeat themselves , hour after hour and day after day.  I accept this process as a necessary component of my departure.

But every one rips another small piece out of my heart. 


  1. A very concise embodiment of what it is like to transition to a new practice. I am struggling with the same expressions/glances. No matter how excited I am for new opportunities, I still find it difficult to reconcile this process a family practice physician. Continuity and relationships are so valued, and in these visits you really appreciate what they mean. Still rips your heart out and for me can't help but inspire some pangs of guilt, but so it goes.

    Great post Dr. Middleton.

  2. Nicely written. Our graduating residents just sent out goodbye letters. I have no plans to leave my current position, but the thought of leaving my patients is definitely a deterrent.