Passing over the bridge on my way to work under grey morning skies, I glanced out over the turbulent water. Swollen from overnight rains, raging waves the color of coffee milk danced down the wide expanse below the bridge. Only time would tame the river's fury. But the bridge stood solid on abutments firmly rooted below the boiling waters. I counted on this bridge to get to work every morning and for safe passage home at the close of each day.
As I drove over the bridge, my thoughts turned to Mrs. Pont. I first met her 15 years ago at the community nursing agency. My partner and I were trying to grow a pediatric practice back then. Volunteering at the free well-child clinic seemed a good way to generate exposure in the community. Mrs. Pont ran the clinic; I merely examined the children and talked with their parents. It was a clean, well-lighted place, sparsely furnished but adequate for rendering routine medical care.
One day after the last of the morning patients had departed and I was busy reassembling the contents of my black bag, Mrs. Pont asked me a medical question. What did I know about Rett syndrome? How familiar was I with it? Had I ever seen a case?
I dove down deep into my memory banks and pulled out a few facts. Rett syndrome was a disorder of arrested development found mostly in girls. For some unknown reason, these children first stopped and then regressed in their development, particularly in language and personal-social skills. Hand-wringing was an associated clinical sign. For the moment, that's all I could muster. Why did she ask?
Mrs. Pont told me that she had a daughter—her only child— who had been diagnosed with Rett syndrome at an early age. She was now in an institution, unable to care for herself. Recently, a series of tests had revealed elevation of her liver enzymes. Mrs. Pont wanted to know what that portended, and what could be done about it.
I confessed that I didn't know but would be happy to look into it for her. One thing led to another, and shortly thereafter, the well-child clinic lost its funding. Our practice had picked up in the meantime, and my promise to Mrs. Pont was inadvertently pushed to the back burner.
Years later, two new patients appeared on my schedule: both boys, each with a different last name. They were foster children, placed in a private home by the state. Each one had his own sad story to tell. But the good story is that the foster mother turned out to be Mrs. Pont.
After the clinic closed, she had left nursing to care for her ailing mother. At some point she read an article in the local paper about the pressing need for foster households and decided to apply. Eventually, she would take in three foster children—all boys—and raise them as her own. Two of the three were asthmatic. Because of her nursing background, Mrs. Pont was able to handle their care with expertise.
Several times, her mother accompanied Mrs. Pont and the boys on visits to our office. Later, Mrs. Pont confided to me that her mother's colon cancer had come back. There was little to be done apart from palliative care.
Her mother died in the fall of that year. Mrs. Pont brought a fruitcake to the office over the holidays. “For taking such good care of my boys,” she said, as she handed the decorative tin box through the sliding glass window. I telephoned to thank her later that afternoon. “How are you doing these days?” I asked.
“OK,” she said. “This is the first Christmas without my mother, but I have my boys. They're doing well.”
“Good,” I said. Then, almost as an afterthought, I asked about her daughter.
“You remember,” she said.
“Yes. I'm afraid that I never got back to you on your question about her condition.”
“It turned out to be hepatic encephalopathy,” she told me. “There wasn't anything they could do. She passed away shortly after the clinic closed.”
“I'm sorry—I never knew.”
“One less burdened soul,” she said. “Now I have my boys.”
My thoughts returned to the river, raging from the recent rains. I thought about the bridge, firmly anchored, unwavering, immoveable—the bridge that I depended on daily for safe passage over these troubled waters.
In his novella The Bridge of San Luis Rey, Thornton Wilder writes: “We ourselves shall be loved for a while and forgotten. But the love will have been enough; all those impulses of love return to the love that made them. Even memory is not necessary for love. There is a land of the living and a land of the dead and the bridge is love, the only survival, the only meaning.” 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 www.lulu.com/briantmaurer.