One Last Signature

Benjamin “Bip” Alderton died yesterday morning. The Hospice nurse called a few minutes after eight, but I already knew; in a small town everyone always knows these things. I recorded the telephone call on our usual sticky-form:

Date:                           10/3/08
Time:                          08:22
Patient’s name:           “Bip” Alderton
Caller’s name:             Heather Snow, RN
Problem:                     Patient passed away peacefully at 05:30.
Plan:                           (I left this blank)
Physician’s Signature: (Signed)

Within two hours the funeral parlor’s typical glossy brown marble-like document folder appeared at my desk with his death certificate. I paused for a few moments before I opened it.

I moved to this area in 1985. The clinic had located a house for rent just a few miles away, a lovely early 1800’s center-chimney cape with crooked wide pine floors, original wainscoting and a nice yard for their newly recruited 32 year old doctor’s young family.

“Bip” Alderton was my next-door neighbor. I never did learn why people called him “Bip”. He was 55, the age I am now, worked at the mill and did some lobstering on the side. He became my patient, and although we were never close, we saw each other often enough that our lives intertwined when things happened to each of us.

His wife died from heart disease, and then when he was about seventy, he was severely injured in a car accident. Always a stubborn man, he learned to walk again, and within a couple of years you had to look hard to notice his limp and the pain he was in – he never complained, and never took anything for it after the first few months.

He developed atrial fibrillation, and had to take a blood thinner, so I saw him often as he came in for his blood tests to have his warfarin dose regulated.

Then, suddenly this summer, his prothrombin times started to fluctuate wildly. He hadn’t changed his diet, didn’t seem to have mixed up his pill bottles, and hadn’t taken any new medications or supplements. We both scratched our heads.

The explanation didn’t take long to reveal itself. Over just a couple of days, he developed jaundice and lost his appetite. His CT scan demonstrated widening of his bile ducts and the head of his pancreas looked enlarged.

A gastroenterologist did an ERCP procedure and was able to place a stent that opened his bile duct where it passed through the tumor, and a cancer surgeon offered “Bip” an operation called a Whipple procedure, which at age 78 is an almost heroic thing to do.

“Bip” thought about it for a few days, but decided against it. He had some pain and lost weight, but the stent worked for a couple of months. We got Hospice involved, and they kept him comfortable. Periodically they called for updates and new medication orders, all properly documented and signed in his thick medical record.

I opened the brown document folder and read the entries filled in by the funeral parlor: Place of birth, ethnicity and so on. Then I completed my part, in black ink:

Cause of death:                               Pancreas cancer.
Time between onset and death:       4 months.
Other contributing diagnoses:        (I thought about losing a wife and almost being killed in a car accident, but left this field blank.)
Did you view the body after death: No.
Certifier’s name and address:         (done)
Signature:                                   I put my signature on the last piece of paperwork in the medical history of my friend and neighbor, and carefully closed the document folder.

I was still thinking about how comfortable it had been to have “Bip” and Ellen right next door that first year here when Autumn startled me by tapping me on the arm:

“Mrs. Pye’s lab work is back!”

1 Response to “One Last Signature”

  1. 1 elaine October 5, 2008 at 7:52 am

    A grand and moving farewell to a grand old man.

    And then, back to reality and the knowledge that life indeed moves on.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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