Published courtesy of the Annals of Internal Medicine. Copyright ©2000 American College of Physicians – American Society of Internal Medicine [return to Dr. Rensenbrink's profile]  Requests for Single Reprints: Kathryn Rensenbrink, MD, Ellsworth Internal Medicine, 50 Union Street, Ellsworth, ME 04605. Requests To Purchase Bulk Reprints (minimum, 100 copies): Barbara Hudson, Reprints Coordinator; phone, 215-351-2657; e-mail,  bhudson@mail.acponline.org.

In the rural Maine town where I now practice, my patients are also my neighbors. I find myself discussing inhalers in the bakery and clarifying diuretics in line at the supermarket. "Yes, Mr. Randolph, the one that makes you pee." My patients see me in dirty sweats at the Y, they hear my half-muttered invectives to the referee during high school basketball games. I've traded the safety and authority of anonymity for membership in a community.

My way home winds along a country road through fields and woods with occasional startling glimpses of the sea. Only 3 years in practice, and already the road is crowded with stories. Here lives Susan, who remembers riding to a dance in the town's first motorcar; here lives John, who triumphs slowly over a stroke. And here stands the empty house of Dr. Smith. A physician till the end, he requested his own autopsy, adding "be sure I receive a copy."

At the curve in the road by the beach lies Bridgett's house. I visit occasionally to enjoy tea and fruitcake, her late husband's favorite. We talk of neighbors, her daughters. When our conversation turns to Dan, her eyes reveal an enduring disbelief that she should be left so much alone. He died at home, a second cancer making merry in a body humbled by the first. "Enough of chemotherapy and transfusions," he'd said, and returned to his view of purple mountains. I made a home visit on his last night. "Is it time?" his family asked. "Are we doing as we should?" "He was in pain; we gave an extra pill." I reassured and comforted them, feeling puny before the unknowable. He passed quietly at dawn. Later, his daughter sent a letter thanking me for my visit "for coming like a guardian spirit out of the winter dark." How wonderful to be most appreciated when you feel the least able.

A bit farther along, I pass Sharon's lovely cottage, where I often slow to avoid her nonchalant cat. I met her in the hospital after her husband, Martin, 50, collapsed in cardiac arrest at a local hardware store. When I picked up the hospital service, he was on a breathing machine, with worsening kidney failure; he had not regained consciousness, maybe never would. I spoke with Sharon and her two children. Did they understand what has happening? Did they know what Martin would want? His intelligence and wit, they quickly agreed, were most important. "We would play six-on-one Trivial Pursuit and he would still win." They laughed, a flash of pride and love sweetening their sadness. So I sent him to the tertiary care hospital for an EEG. Shortly after the neurologist had shared her grim prognosis, Martin's heart stopped again, and his brave family let him go.

In the city where I trained, my relationship with these men and their families would end there. I would mull over their fate, evaluate my role, and move on to the next assignment. Not so now. Just before I reach my house, I again pass Dan and Martin, the newest inhabitants of a small cemetery whose stories span three centuries. I like to walk among the quiet white stones, pulled up in neat rows like pews in an invisible church. (Whether a church for the dead or for those left living, I'm not sure.) At the back, Bridgett has placed a stone bench and planted an herb garden over Dan. Martin lies nearby under a graceful maple. The care given these graves shows me that, though dead, these men remain part of our neighborhood.

I mentioned this thought to Bridgett one day over tea. She then asked if I had noticed the pretzels. Pretzels? "To commemorate the anniversary of my husband's death, my daughter and I walked to the cemetery. After making our tribute to Dan, we visited the nearby graves. We saw what looked like pretzels scattered on Martin. I later asked Sharon if she knew what they were, but she claimed to have no idea." Bridgett's eyes laughed. "I didn't believe her, so I asked again. Finally, she conceded that she had put them there. They had been her husband's favorite." The laugh spread from eyes to mouth as Bridgett went on. "Sharon was mortified until I told her I only found Martin's pretzels because I was there spreading fruitcake for Dan."

Requests for Single Reprints: Kathryn Rensenbrink, MD, Ellsworth Internal Medicine, 50 Union Street, Ellsworth, ME 04605.

Requests To Purchase Bulk Reprints (minimum, 100 copies): Barbara Hudson, Reprints Coordinator; phone, 215-351-2657; e-mail, bhudson@mail.acponline.org.
Copyright ©2000 American College of Physicians – American Society of Internal Medicine