Losing a feisty – but grateful – patient

I’d known Jerry for over a year. When I first met him it was because he had gotten admitted with fevers and an elevation in his erythrocyte sedimentation rate. In the absence of an obvious infectious cause, I was called to see him.

He was such a character. His intelligence was evident. The day that I met him he told me that he was a retired journalist, and that he planned to write a book. His subject was to be one of the presidents, as he had a real interest in history. I particularly enjoyed hearing his "This I Believe" essay on Rhode Island’s National Public Radio about how people these days get so attached to material things, and how far removed this reality is from how he grew up.

He was feisty and opinionated. He, like many other elderly men, thought he knew best, and told everyone – doctors, nurses, his wife – how to do their jobs. He fired his primary care doctor because the doctor told him he couldn’t drive anymore. He stopped his Coumadin because he established, "after applying the scientific method" (i.e., having rechallenged himself with it), that it caused severe pruritis that he just was not willing to put up with.

In the winter of 2012, he developed what seemed to be new-onset Raynaud’s, coincident with a worsening of his thrombocytopenia and anemia. His blood pressure was too low for him to tolerate a calcium channel blocker. I suggested sildenafil, but it was not until mid-June that he came to me asking to be put on it because the condition had progressed quite rapidly, he had developed ulcerations, and he was in a lot of pain. By then we knew about the non-Hodgkin’s lymphoma on top of his preexisting myelodysplastic syndrome, and he was about to get a second opinion about getting a second bone-marrow biopsy at Dana-Farber Cancer Institute.

After the inevitable battle for insurance coverage, we managed to get the sildenafil approved for him, and it made such a huge difference that on July 26, he wrote me, by snail mail, a letter of gratitude: "The lesions are slowly vanishing, the ailing fingernails are taking deeper breaths and thickening, the fingertips are getting firmer. Your compassion, skill, and determination to aid your patients have defeated dis-ease." No doubt he really meant dis-ease, as he repeated the unusual formulation later on. He had such a way with words.

"I looked forward to another winter here with horror. But, thanks to your determination to help ... I am canceling my plans to escape to Florida."

He ended the letter with an invitation to take me to my favorite dim sum restaurant in Providence that I had recommended to him and that he liked as much as I did. He planned on taking me there in mid-August. "I don’t believe that Hippocrates would scorn such an invitation. Let me show off my fingers!"

This was not the first time that he’d invited me to dim sum, but it was the first time that I actually considered accepting the offer, having been granted imaginary permission by Hippocrates.

Jerry passed away on Aug. 1. I was too late for dim sum.

"My soul is from elsewhere, I am sure of that. And I intend to end up there." –Rumi

Dr. Chan practices rheumatology in Pawtucket, R.I.

I’d known Jerry for over a year. When I first met him it was because he had gotten admitted with fevers and an elevation in his erythrocyte sedimentation rate. In the absence of an obvious infectious cause, I was called to see him.

He was such a character. His intelligence was evident. The day that I met him he told me that he was a retired journalist, and that he planned to write a book. His subject was to be one of the presidents, as he had a real interest in history. I particularly enjoyed hearing his "This I Believe" essay on Rhode Island’s National Public Radio about how people these days get so attached to material things, and how far removed this reality is from how he grew up.

He was feisty and opinionated. He, like many other elderly men, thought he knew best, and told everyone – doctors, nurses, his wife – how to do their jobs. He fired his primary care doctor because the doctor told him he couldn’t drive anymore. He stopped his Coumadin because he established, "after applying the scientific method" (i.e., having rechallenged himself with it), that it caused severe pruritis that he just was not willing to put up with.

In the winter of 2012, he developed what seemed to be new-onset Raynaud’s, coincident with a worsening of his thrombocytopenia and anemia. His blood pressure was too low for him to tolerate a calcium channel blocker. I suggested sildenafil, but it was not until mid-June that he came to me asking to be put on it because the condition had progressed quite rapidly, he had developed ulcerations, and he was in a lot of pain. By then we knew about the non-Hodgkin’s lymphoma on top of his preexisting myelodysplastic syndrome, and he was about to get a second opinion about getting a second bone-marrow biopsy at Dana-Farber Cancer Institute.

After the inevitable battle for insurance coverage, we managed to get the sildenafil approved for him, and it made such a huge difference that on July 26, he wrote me, by snail mail, a letter of gratitude: "The lesions are slowly vanishing, the ailing fingernails are taking deeper breaths and thickening, the fingertips are getting firmer. Your compassion, skill, and determination to aid your patients have defeated dis-ease." No doubt he really meant dis-ease, as he repeated the unusual formulation later on. He had such a way with words.

"I looked forward to another winter here with horror. But, thanks to your determination to help ... I am canceling my plans to escape to Florida."

He ended the letter with an invitation to take me to my favorite dim sum restaurant in Providence that I had recommended to him and that he liked as much as I did. He planned on taking me there in mid-August. "I don’t believe that Hippocrates would scorn such an invitation. Let me show off my fingers!"

This was not the first time that he’d invited me to dim sum, but it was the first time that I actually considered accepting the offer, having been granted imaginary permission by Hippocrates.

Jerry passed away on Aug. 1. I was too late for dim sum.

"My soul is from elsewhere, I am sure of that. And I intend to end up there." –Rumi

Dr. Chan practices rheumatology in Pawtucket, R.I.

I’d known Jerry for over a year. When I first met him it was because he had gotten admitted with fevers and an elevation in his erythrocyte sedimentation rate. In the absence of an obvious infectious cause, I was called to see him.

He was such a character. His intelligence was evident. The day that I met him he told me that he was a retired journalist, and that he planned to write a book. His subject was to be one of the presidents, as he had a real interest in history. I particularly enjoyed hearing his "This I Believe" essay on Rhode Island’s National Public Radio about how people these days get so attached to material things, and how far removed this reality is from how he grew up.

He was feisty and opinionated. He, like many other elderly men, thought he knew best, and told everyone – doctors, nurses, his wife – how to do their jobs. He fired his primary care doctor because the doctor told him he couldn’t drive anymore. He stopped his Coumadin because he established, "after applying the scientific method" (i.e., having rechallenged himself with it), that it caused severe pruritis that he just was not willing to put up with.

In the winter of 2012, he developed what seemed to be new-onset Raynaud’s, coincident with a worsening of his thrombocytopenia and anemia. His blood pressure was too low for him to tolerate a calcium channel blocker. I suggested sildenafil, but it was not until mid-June that he came to me asking to be put on it because the condition had progressed quite rapidly, he had developed ulcerations, and he was in a lot of pain. By then we knew about the non-Hodgkin’s lymphoma on top of his preexisting myelodysplastic syndrome, and he was about to get a second opinion about getting a second bone-marrow biopsy at Dana-Farber Cancer Institute.

After the inevitable battle for insurance coverage, we managed to get the sildenafil approved for him, and it made such a huge difference that on July 26, he wrote me, by snail mail, a letter of gratitude: "The lesions are slowly vanishing, the ailing fingernails are taking deeper breaths and thickening, the fingertips are getting firmer. Your compassion, skill, and determination to aid your patients have defeated dis-ease." No doubt he really meant dis-ease, as he repeated the unusual formulation later on. He had such a way with words.

"I looked forward to another winter here with horror. But, thanks to your determination to help ... I am canceling my plans to escape to Florida."

He ended the letter with an invitation to take me to my favorite dim sum restaurant in Providence that I had recommended to him and that he liked as much as I did. He planned on taking me there in mid-August. "I don’t believe that Hippocrates would scorn such an invitation. Let me show off my fingers!"

This was not the first time that he’d invited me to dim sum, but it was the first time that I actually considered accepting the offer, having been granted imaginary permission by Hippocrates.

Jerry passed away on Aug. 1. I was too late for dim sum.

"My soul is from elsewhere, I am sure of that. And I intend to end up there." –Rumi

Dr. Chan practices rheumatology in Pawtucket, R.I.