With clinician burnout, depression, resilience and joy in practice so prominent in the primary care literature lately, I have been reflecting on my own career, and the times I experienced the most joy professionally. Looking back, I think it was the years I worked with Chris (not her real name). Chris, a home health nurse, was at first simply a bubbly voice on the other end of the phone. She had been covering for someone on a day I needed to order home health care for a frail elderly patient recently discharged from the hospital. At that point in my career, I had worked with a few home health agencies, but my relationship with them had been mostly signatures on forms. With Chris, communication was different. First, she called me. Second, she called me before the patient became unstable, often when there was a chance we might adjust a treatment plan and prevent a bounce back. She was proactive in helping patients stay out of the hospital, buying a scale for a patient with CHF or a clock with large numerals for a patient struggling with medication dosing. Chris once adopted a cat from a patient who had entered hospice and passed away. Perhaps the most important difference about Chris was a sense I got when working with her that not only did Chris have the patients’ back, but she had mine as well. She gave me her cell phone and pager numbers to make real-time conversations easier. I knew if Chris called, it was going to be important. She would often make weekend visits on our mutual patients “just to say hello.” I could exhale when Chris was on. I began to ask that Chris be assigned to all my patients requiring home health care. Over time, I came to know more about her. Chris was calm and quick to take on a challenging situation with a patient with a laugh and a smile. She had colorful euphemisms. To describe a patient who loved to talk and make phone calls, but was stable, Chris said the patient was, “dialing for dollars.” Yet, I knew that Chris would double check to evaluate the patient with a visit. When I moved to a different health system, I lost touch with Chris. Soon after my move, I was awarded a small grant from a visiting nurse association to teach family medicine residents about house calls. I needed a nurse, and, of course, the first person to come to mind was Chris. “Where have you been?” she said when I called her, eagerly jumping into accepting the position despite her busy schedule. It was during this program that I got to know Chris even better, riding shotgun with her to visit geriatric patients. I learned she loved golden retrievers and camping. She wanted to travel around the country in an RV. It was in those car rides and on those visits that I came to respect Chris even more, seeing her down-to-earth style put patients at ease. Frankly, I began to notice that I felt more at ease myself. In fact, I began to look forward to our house calls. I found that often my most complicated patients, the ones I had the most difficulty managing, transformed into some of my most rewarding encounters when I saw them in their homes with Chris. We would double-team the visit. Chris would do the medication reconciliation and home assessment, while I did the exam. Together we would come up with a plan, deciding whether the patient needed medication adjustment, labs, social services, physical therapy, meals, light housekeeping or a companion. We discussed how frequently the patient required face-to-face monitoring. Often, Chris would circle back to check on the patient a day or two later, and call me with an update. The efficiency of our tandem visits paid off. I will never forget how we helped a frail, elderly woman who lived alone, stay in her home as she desired, despite a myriad of medical problems including mild cognitive impairment and autonomic dysfunction with syncope. Working together, Chris and I were able to anticipate her needs and enlist help from her family. We encouraged family members to purchase a window air conditioner during the sweltering summer heat. We helped bring in additional 24-hour caregivers. Together, we facilitated getting an advanced directive in place so that the patient at the end was able to stay in her beloved apartment with hospice. Honoring her final wish, she died peacefully in her bed at age 89. Through two health systems and 11 years, I shared the care of some of my sickest patients with Chris. As a result of a hospital merger, I made a career change and moved out of state, but stayed in touch with Chris. By that time, we had become friends. Not long afterward, she was diagnosed with late-stage ovarian cancer. She remained upbeat. During one of my visits, she was dealing with ignition problems on her RV. We sat talking in the RV cab on a cold winter’s afternoon waiting for the mechanic. Chris thanked me for all I had taught her. “No,” I said, “thank you.” I told her she had made my work, shouldering responsibility for those frail elderly patients, not only easier, but, honestly kind of fun. Chris had a hard time taking a compliment, but she smiled at my words. “It was fun,” she said, a twinkle in her eye. Chris died about a year or so after our wintery conversation in the RV. It’s been over 17 years since I worked with her. Yet, our partnership remains a unique highlight of my professional career. Why? We worked side by side. We had virtual contact when apart, mutual commitment to patients, trust and respect for each other. I knew Chris had my back. Joy in practice? For me, it was the years I worked with Chris. It was then I learned the power of two. Maureen A. Mavrinac is a geriatrician. Source
