Snow in Summertime

Journal of Family Practice, July, 2000 by Anthony Valdini

Rose and Frank lived in a gray bungalow at the beach. You pass these places all the time down at the shore: a crumbling screened-in porch attached to a teeny house originally intended for a summer's escape, now a home year-round. Plastic creatures decorate the sandy lawn next to a long-unused swing set, a vegetable and flower garden, and a rusting car in the driveway. White paint peels from the rotting woodwork and the steps to the screen door threshold.

The couple transferred into my practice one summer, after their resident physician had graduated. "We want a doctor who will still be here after we're dead," Frank explained. "We don't want to have to change again. It's too hard after we've become attached." At our first meeting we talked about their previous doctor, their hopes that I would be just as nice, their multiple medications, and their relationship with their son, Joe. Frank was still driving at that time; he described his routine in a just-between-us-husbands way. He would drop Rose off at the front of the hospital and then race down from the parking lot to wrestle a wheelchair for her, "so we can get here in one piece." The trip from the front door to the family practice center was long and confusing. Rose seated in a rolling chair was a much more stable arrangement than teetering through tertiary care center chaos. We set up a plan to keep the medications going and to visit once a month. "Keep an eye on us, Doc," he said.

Rose and Frank were true to their monthly schedule. The problem was that after a lifetime of hard work they were old and sick, with only Joe to lean on. He had a life apart from theirs, stretched between the responsibilities of work and his wife and children at home. His one diversion was coaching his son's peewee hockey team. Within the year, Frank had 2 auto accidents and was forced to give up his keys and his car. Joe took over driving his parents, and their visits continued like clockwork.

At every visit the pair would ask me about my family: "Do you have children, Doctor? Boys or girls? Do they have red hair like you? What does your wife do?" The questions, although personal, seemed harmless. Hearing that I did have children fueled their desire to know more.

I would ask if Rose thought she could get onto the examination table, and she would ask to see pictures of my kids. "what do you mean you don't have any?" she said. "When we come back next time you'll bring them in, won't you? You know we're old, but we won't forget."

They didn't. The satisfaction of seeing the little picture faces led to the next request: "When are you going to bring your boys over to our house?" "Maybe sometime when it's warm," I answered, wondering if they would remember. Our monthly visits marked a slow but noticeable decline in Rose. We adjusted her digitalis, manipulated her diuretic, and sweet-talked her into taking liquid potassium. Joe bought a "big number" scale, and Frank put her on it every day. We worked out a system for predicting problems, and it mostly worked okay.

During the spring, Frank wanted to explore my background a little more. "where do your people come from?" he asked. Hearing the right answer emboldened him. He launched into a little speech in Italian, hoping I'd pick up the trail. "Non parlo Italiano molto bene," I replied. We were both disappointed.

After a year of juggling and hoping, Rose's congestive heart failure limited her to movement from bed to chair to toilet. We still met monthly, catching up on holiday plans, grandchildren, the garden, and recipes. While Frank taught me how to cook cocozza with fish and other vegetables, I did what I could to keep him afloat, so he could care for Rose.

At the visit after a brief admission for cardiac decompensation, Frank was clearly rattled. He said to me, "You know, this time, I thought we lost her." He picked up her hand. Rose looked at him with tenderness, understanding that their time together was limited. She'd known for a long time what he had just now realized. "I love her Doc, I just love her, and I don't know what I'd do without her," Frank fretted with his head on Rose's shoulder. After a few quiet moments we planned to meet in a month.

Rose held on, living through another winter. In April, she came in wearing a pink dress left over from a long-ago wedding (her daughter-in-law got her ready that day), and she looked hopeful. Frank was affectionate, kissing her cheeks with loud wet smacking sounds. "You know Doc, she's not even Italian?" Frank said. "Our families didn't like it." Rose agreed, "They said that ginzos beat their wives. Frank had a temper, but he wouldn't ever lift a finger to me." Joe came in at the end of the visit, and we worked out a deal. Since it was so difficult for him to get time off from work to bring Mom and Dad, I agreed to visit them at home every other month.

May's home visit went fine. The house was cluttered with old furniture, broken appliances, dangerous throw rugs, and no railings or safety equipment anywhere, including the shower. Frank insisted I have a glass of wine with him. "You can't come all the way out here and not let us give you anything." We were sipping Chianti wine out of jelly glasses and looking at the garden when Rose called me back to her bedroom: "Bring your son when you come back. If you come Saturday he won't miss any school."