Behind Closed Doors

“No one knows what goes on behind closed doors.”

Charley Rich sang this country song

I met him long ago, when I still had hair and could eat whatever I wanted.  I don’t remember who led him to my practice.  In so many ways representative of many of my male patients.  He had spent his life performing manual labor.  In those days factories were thriving and men who had little education could make a nice living making things.  A dyed in the wool union man; a patriot who enjoyed yardwork and Sunday barbecues.  He had unyielding opinions on everything, no matter how little he knew about the subjects being discussed.

He was strong.  Built like a rectangular rock.  He loved to work; I think between the factory and the house he put in eighty hours a week; easy.  Later on, when I got to know him better, I realized that he couldn’t stand still even if he had wanted to.  His mind; his projects never stopped.

His wife came to his appointments with him.  She was bright, soft spoken, and beautiful.  She sat on the chair we use for family members, note pad in hand, and wrote down everything I said had to be done.  At first I felt this behavior was a bit overbearing, but within a year I realized that he had no idea, no notion of how to take care of himself.  She laid out his clothes in the morning; fixed his lunch; had dinner ready in the evening; reminded him of every little detail (I think that he was capable of showering and brushing his teeth on his own, but really it didn’t go much beyond that).

The more I got to know this couple the deeper I sank into a bottomless pit of curiosity.  She was way smarter than he was.  She was classy; he was… let’s say common.  She had a great job of her own; she had much responsibility and made many decisions.  He was best suited for following a set pattern that was explained to him.

And his temper!  By the time he came for the third time my staff cringed when they saw his name on the list of appointments for the day.  A five minute delay was enough to trigger a nasty comment.  He complained if his lab studies were not explained to him in enough detail, and walked out of the room whenever they tried to make him understand anything.  He was loud; obnoxious; difficult.  Many times my nurses would wait until he left, quietly come up to me, and say: “What does she see in him?”

And yet…  There was something about the man.  He was obviously proud of his two daughters.  Whenever he became a bit rowdy his wife looked away from him, then back at him, and I could tell that he felt guilty.  I learned (quickly) from her.  I refused to listen to his unpleasant bursts and if needed came right back at him with a barb of my own.  At that point he would smile and calm down.

So it went for several years.  The factory closed, but there was enough money to retire with comfort.  He continued to work his eighty hours, only he did so at his house.  His place must have looked like a palace.  He gained weight; his knees began to break down; he came up with diabetes, and hypertension.  Not a day went by that he did not have some form of pain.  This infuriated him.  He could not understand or accept his ailments.  Time and again he asked for a cure; at every visit I reminded him the cure lay in eating healthy.  He would half way scream at me that he could not do this, and he walked out of the office visibly upset.

Through all of this she remained a model of restraint and compassion.  One day, as he was ranting about how his knee pain was unbearable, I shot a glance at his wife.  She looked tired, and she had lost some weight.  I asked her how she felt.

“A bit tired.  Can’t seem to get enough rest.”

You need to see your doctor.  You look ill.

“You are my doctor.”

Since when?  I’ve never seen you as a patient!

“Because there was nothing wrong with me.  I always assumed you were my doctor.”

I took a quick look.  Not good.  She was jaundiced.  Her muscles were atrophied.  I ordered a few tests; again not good.  She had cancer of the pancreas with liver metastases.

The prognosis was dismal.  I went in her hospital room to explain what she faced.  She decided against any treatment, mostly because she knew her husband would not be able to handle taking care of her.  She saw no sense in prolonging matters.

A couple of days went by.  I tried to adjust her pain medicine, and in vain sought a remedy for the constant nausea.  As I was leaving her room she asked me to sit down.

“I know there’s no hope for me.  Just don’t let me be in pain.  Give me as much medicine as it takes, even if it kills me.  I don’t want Rick to see me hurting.”

Done.

“One more thing.”  Her eyes filled with tears.  “Promise that you will take care of him when I die.”

I am his doctor.

“No; I mean take care of him.  Make sure that he eats regular; that the bills are paid; that he has enough to do no matter how much he complains of pain.”

I sat speechless.  She didn’t really want me to move in with him, did she?  I squeezed her hand.

“One of our daughters will move in with him.”  Noticeable sigh of relief from me.

“She does not know much about medicine.  Help her; make sure he’ll be OK.”

Of course I’ll do that.  I promise.

She smiled, then cried some more.  She died that evening.

Rick’s daughter and his doctor, bound by his promise, fulfilled their vows.  We made sure that he was seen every week at first, then at steadily longer intervals.  All instructions were carefully written down.  Rick’s daughter handled the finances admirably, and to my embarrassment made sure that I saw the numbers every month.  Rick, to my surprise, did well.

Two years went by.  His daughter got engaged; she would be married soon.  Rick brought a woman to his next appointment.  He had met her through a widow/ widower group.  She was smart; very formal; very taken by him.  Soon they married.  I was released from my obligation, but he remained my patient.

This very coarse and sometimes exasperating man managed to find two jewels that had no problem being a combination of mother and wife to him.  To this day I don’t understand how this came about.  I decided that for sure once they went home he became a different person.  Behind closed doors.

Rick died ten years later.  His numerous ailments caught up with him.  His daughter, the caregiver, delivered a stirring tribute to her dad at the funeral service.  His second wife still misses him.