Not a bad day today. No substance abusers. Mostly saw real people with real problems and several no shows for appointment.

The subject of grief and loss is unavoidable in my line of work, mostly because such a process is at the root of much of the unhappiness we experience during our lifetime. I'm thankful for the last couple of months even though there has been more than the usual amount of grief in my own personal life. I visited my father in the nursing home last night and talked with him during a fit of sundowning, better known as acute delirium. He's down to about 85 pounds and confined to the bed in a diaper. His hallucinations seemed a bit frightening for him but there was a child-like quality to his voice as he urged me to pull and push him through whatever place he was trying to escape.

He asked me to not let him die. I asked if he were afraid to die? He replied he wasn't afraid but he didn't want to die. Here I was, the mighty physician, reduced to utter helplessness. I could try soothing him and telling him that he was okay and everything was going to be alright. That actually seemed to help. Just last week I had told a grieving and guilt ridden patient that at a certain point of illness it doesn't matter what we humans do because it is out of our hands. Still I felt useless. I was able to hold his hand and tell him he was loved. For me that is a major accomplishment for such words usually come with great effort.

Hospice teaches us that a time comes when we can give our loved one permission to go. I couldn't quite find the appropriate words for that. I wondered what motivated him to fight so hard to hang on at this stage. His 90th birthday is in a week. Maybe that's the reason. I gave him a sip of water and he would not release the straw from his lips. I felt numb as I looked at the empty bed his roommate left as he departed this life as I exited the room. I felt guilty for leaving but the imagery was more than I could emotionally continue to deal with. Death in the theatre and story books does not happen this way. I began my grief in June and I don't think I'll cry again until I learn of my father's passing. I'm thankful and glad that God allowed these extra weeks for me to try and prepare, as much as one can prepare for the passing of a loved one. I realize that some things are even worse than death. Suffering with no quality of life is one such thing.

Medical School introduces the physician to the art of healing. Soon we learn the limits of this art and realize that without the cooperation of our patient and the will of God we can easily be rendered useless. My last patient today was a 20 year old young man amidst his first psychotic break. I started him on medication a couple of months ago to which he responded but struggles with compliance issues. He is uninsured, unemployable at this time, and his mother works 2 jobs. She has payed out of her pocket for his visits. He opened up more to me today about his impaired thought process and thoughts of suicide. I've worked in the Mental Health Center and I don't feel it in his best interest that I send him there just because he cannot pay. I believe he is worth saving and as long as he and his mother remain committed I will try and work with him and help him pursue disability. I suppose the reality of not being able to help my father has helped me see more value in helping someone not beyond the benefit of human intervention and compassion.