I had seen Eldon Beauford almost every week for the last six months to monitor his congestive heart failure. Every time his weight went up, I temporarily increased his diuretics, and every time his heart rate was faster or slower than ideal, I adjusted the medications we used to rate-control his atrial fibrillation. Sometimes he would have episodes of shortness of breath with exertion that sounded more like atypical angina, in which case I adjusted his nitroglycerin regimen.
Eldon would move slowly as he began his day, weigh himself, then take a nitroglycerin before shaving and washing up. He followed a severely salt-restricted diet, and he took almost a dozen different pills.
His vital signs changed with every visit, and we patiently tinkered with the medications we had collected as tools to treat his ailing heart. He always seemed to want to be part of the decision-making process; I would explain my assessment, and he would generally agree to my plan, but not without double-checking my rationale.
He was no longer taking blood thinners for his atrial fibrillation after two hospitalizations for intestinal bleeding. The gastroenterologist and anesthesiologist who saw him in consultation both felt he was too frail to tolerate the anesthesia or endoscopy procedures to diagnose the bleeding. To continue with blood thinners in the face of ongoing intestinal blood loss would have been too risky, so we chose the less dramatic risk of leaving an almost 90-year-old man with atrial fibrillation without blood thinners, but with an increased risk of stroke.
Some visits I knew Eldon was getting better. He would tell me about places he had been and things he had done. Other visits, we seemed to be slipping backward in spite of all the medications we were using. He knew how precarious his situation was, and his expectations were small. He always seemed able to celebrate even the smallest victories.
A while ago, he took the bus downstate to spend a week with his daughter and son-in-law. He hadn’t seen them since Christmas, and spoke for weeks about his excitement to see them, their children and grandchildren.
Shortly after his return, his congestive heart failure flared up, and he suffered a fatal stroke. In the days that followed, I couldn’t get him out of my mind. He was such a gracious man, who lived life to the fullest within his severe limitations. I so wished I could have helped him more.
In Friday’s mail I got a card, with a postmark from near the southern border of the state.
The card read:
Thank you for the wonderful health care you provided for my father, Eldon Beauford. You always treated him with respect and compassion. You successfully managed his heart failure and enabled him to live the best quality of life that he possibly could. We were lucky to have you there for him.
Sincerely,
Diana Daigle
I tucked the card away with others like it I keep in a drawer, mementos of patients and families whose lives I have been fortunate enough to touch over the years.
A Country Doctor Writes: 
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