IN TOUCH

God Bless the Glendas

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Scott Matthew Bolhack, MD, CMD

Glenda, the nurse from the skilled nursing facility where Iwork, came by my office this morning on her way to work. Shedropped off a note at the front desk for me. It was handwrit-ten; not a voice mail, an e-mail, a text, or a tweet. It wasfolded over and sealed loosely with scotch tape. She wroteit and delivered the note before I made it in to the office.The note simply said:

‘‘I wanted you to know that Mrs. Stevenson passed away this

morning at 3:30 AM. – Glenda’’

Mrs. Stevenson was at another facility where I had caredfor her. At that time, I helped her transition to palliation,rather than traditional care, for her ovarian cancer. It wasan easy decision for her. Nonetheless, I remember that Iwas proud and she was appreciative, that palliative care hadbeen ‘‘offered’’ to her as an option. She completed her physi-cal therapy at this facility and then transferred to Glenda’s fa-cility to be on the same campus as her husband.She lived another 2 years. She suffered a massive stroke

along the way, but at all times was persistent in her courageto just keep herself comfortable. And everyone at the nursinghome did just that.In my 2 decades of medical practice, I often find out about

the deaths of my patients from the obituaries, sometimes froma neighbor of the patient who I also take care of, and some-times at facility meetings. The fragmentation of care, even

ss correspondence to Scott Matthew Bolhack, MD, 1775 East SkylineSuite 101, Tucson, AZ 85718. E-mail: sbolhack@tlchealthcarecompanies.

shed by Elsevier Inc. on behalf of the American Medical Directorsiation, Inc.

0.1016/j.jamda.2011.02.011

Bolhack

in the spectrum of primary care, has removed the primarycare physician from the most intimate of human experiences.

We send patients to hospitals to be cared for by hospitalists,who send patients to nursing homes to be cared for by nursinghome specialists, who send patients home to be cared for byhome health nurses or to hospices that have their own palli-ative care physicians. Too often, too little communicationamong these primary care silos takes place. The physicianwho cared for the patient for years is simply left out of someof the most important decisions. Patients are exposed to therotation of hospitalists, a nursing home and nursing homephysician they had little or no choice about, a home healthcompany that is totally unknown to them, or a hospice andpalliative care physician they have little knowledge about.And then when the patient dies, the original primary carephysician—often the only clinician in the long stream oftransitions in care—who knew the patient never finds outthat his patient actually died.

So when Glenda came by this morning, I called her tothank her. I had the opportunity to ask if the patient diedpeacefully and if the husband, with whom I had met somany times, was okay. I actually had the occasion to ask if Icould help in any way, when it was temporally appropriate.

God Bless all of the Glendas in our nursing homes who re-member that some physicians still really care what happens totheir patients.

JAMDA – May 2011