I learned that whatever we say means nothing,

What anyone will remember is that we came. 


—Julia Kasdorf in "What I Learned From My Mother"


In my student days, I trained at an urban health clinic. Although we saw the gamut of general medical ailments, my most invaluable lessons came when the doctor and I ventured out into the local community to make house calls.


One summer day, in his Jeep Wrangler, we wound our way through narrow neighborhood streets to a small white house. At the second floor landing, a plainly dressed woman escorted us to a tiny back bedroom.


Sunlight streamed in through clear windows framed with white lace curtains. In the bed lay the emaciated form of a middle-aged man, his arms and legs gnarled with contractures. His eyes darted nervously about, then rested on my face. He opened his mouth, but no words escaped from his throat.


"Which arm is it?" the doctor asked the woman, who stood nearby at the head of the bed.


"The right one," she said. "I was giving him his morning bed bath when I felt something snap."


Gingerly, the doctor palpated the man's upper arm. It seemed to have developed an extra joint midway between the elbow and shoulder. Tears fell down the man's face. Once again the mouth opened, like that of a newly hatched, blind, baby bird, searching for meaning.


"It's broken all right," the doctor said. He reached into his tattered leather satchel and pulled out an elastic bandage and a padded splint. "Here," he motioned to me, "hold this steady while I wrap it.


"Your husband's bones are brittle from years of his being bedridden," the doctor explained. "No sense casting the arm. Just keep it splinted, make sure it's not applied too tight." He showed her how to check the limb for adequate circulation.


The man began mouthing silent words, pleading with moist eyes. "I know, I know," the doctor said, holding the man's hand. "I'll be back to check on you in a couple of weeks."


"She's cared for him at home for 15 years," the doctor told me as we drove away. "Does an excellent job too. He's always clean when I drop by, never saw a bed sore on him."


Our next patient's house was only a few blocks away. This time we were ushered into a dark room where a frail gray-haired slip of a woman lay in a black metal bed. A number of medicinal bottles stood on a marble-top bedside table.


"Let's have a look at that belly today, Bessie," the doctor said, edging back the counterpane. He pulled on a pair of latex gloves and reached into his bag for sterile gauze pads and a roll of tape. Deftly, he removed the serosanguineous, soaked dressing from the umbilicus. I glimpsed the cancerous wound before he replaced the gauze.


"How's your pain?" he asked, stripping off his gloves.


She eyed one of the bottles on the bedside table. "It's bearable—with that," she said.


"You take a sip of that narcotic cocktail whenever you feel you need it," the doctor said. "Have you moved your bowels recently?"


The woman nodded her head. "Yesterday," she said.


"Good. You let me know when you need more of that medicine, okay?"


"Ovarian cancer," he told me back in the Jeep. "Inoperable. She won't give up her house. Otherwise, I'd have her in a nursing home."


Our final patient of the afternoon lived in a tiny brick building on the other side of the ward. The visiting nurse had phoned in, asking us to look at the old man. "I'm afraid it's really bad," she said. "A neighbor alerted us. He's a widower, hasn't left his house in months."


We found the old man seated in an overstuffed chair by a tall window that looked out over a narrow stretch of unkempt lawn.


"Mr. O'Shaughnessy," the doctor said, dropping his satchel on the floor next to the cane at the old man's feet. "How are you doing?" Gently, he lifted the man's chin toward the light streaming in from the window. The entire left ear was gone, replaced by a cancerous crater draining putrid exudate.


"You want to go to the hospital?" the doctor asked.


The old man shook his head.


"You want something for pain?"


Again, that same slight negative shake.


"You want me to drop back to see you in a week or two?"


The man looked up at the doctor's face. "No need to trouble yourself, Doc. I'm sure you've got other patients to attend to."


"I'll call my supervisor," the nurse said as she escorted us to the front door. "There must be something we can do."


"Not if he refuses treatment," the doctor said. "In any case, let us know."


House calls: scenes from a type of medical care I was once privileged to witness, no longer practiced nowadays. Homebodies: patients determined to live out their lives in the familiar surroundings of their own place.


Of this I'm certain: Each one remembered that we came. JAAPA


Brian T. Maurer, PA-C, practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and a member of the JAAPA editorial board. Visit the author at http://briantmaurer.wordpress.com/.