A Gift of Love
I am driving to my patient Pearl’s apartment for the first time. Pearl and I have met in my office for 15 years, and now, we will meet in her home. She’s on hospice care, which means 6 months or less to live. Age 58 is way too young to die.
When her beloved former psychiatrist, Dr. T., left the clinic where she had received care, Pearl was not pleased when her care was transferred to me. Gradually, as she told me about her home, her boyfriend, her neighbors, and her life experiences, our connection grew stronger. “Never give up on a difficult patient,” she often reminded me in those early years.
I drive through clusters of lovely apartment buildings that appear to be well-maintained condos. Is this where she lives?
As I slow down to go over a speed bump, the buildings become plainer, closer together. Neat, simple, and minimal.
I knock on her first-floor apartment door, and a man lets me in. “This must be her boyfriend, Angus,” I think. After Pearl introduces us, Angus kisses Pearl’s cheek and heads out.
“He washes dishes at the inn,” Pearl says. She sits in a reclined cardiac chair under a soft blanket next to an old sofa on which I take a seat. She’s breathing supplemental oxygen through two nasal prongs.
She tells me that her ankles and ribs hurt, no matter what she does. “The hospice nurse gave me a box of medicines for pain,” she says, “but I don’t want to take them unless I have to. I want to stay sharp.” She has been taking ibuprofen.
Pearl survived horrendous childhood trauma too gruesome to describe. Despite what she has been through, she has lived life fully. She has worked in paid positions providing care for others, enjoys time with friends, has a partner, and is close with family.
She was overwhelmingly generous, giving gifts to her care providers for any occasion. When Pearl learned that Dr. T. liked M&M candies, she would surprise him with M&Ms for all the usual holidays and for his birthday—and sometimes, to her own delight, for no occasion at all. She also gave gifts to her current care team, including me.
Over the years, Dr. T. and I helped her understand that it was not necessary to give gifts in order to be treated with respect. No one was going to mistreat her the way she had been mistreated in the past. Gradually, she and Dr. T. came to an agreement that she could give him a card if she wished, but no more gifts, including M&Ms.
When Pearl stopped giving gifts, her care providers interpreted this as therapeutic growth—that she was able to accept care without feeling she had to please those who cared for her.
As I sit with her in her living room, I ask what is on her mind these days.
“The doctor said I have 6 months to live,” Pearl says matter-of-factly. She also says that she is letting everyone know the exact date of her death, which is 6 months from the appointment with her physician when she learned of her prognosis. “I might make myself a T-shirt with this date on it,” she says. We both chuckle. Even now she puts me at ease.
“What else have you been thinking about?” I ask.
“I worry about how my sister will handle my death.” Pearl has been giving her sister a lot of thought. “I’ve come up with a plan that I think will ease my sister’s sorrow. I’ve been preparing 12 boxes for her, one for each month of the first year after I die.”
“What will you put in the boxes?”
“Some useful things, like postage stamps. And some goofy things like a round clown nose that will make her laugh. I hope laughter will remind her of me, of how we laughed together. And some sweet surprises.”
“You remember how you used to give M&Ms to Dr. T.?”
She closes her eyes for a moment and takes a deep breath. When she opens them again, she gazes at a photo on the shelf of a woman who I assume is her sister. “My sister likes M&Ms as much as Dr. T. does. I’ll put M&Ms in her boxes, for sure.”
She turned her head to look at me directly. “It took me a while to understand what Dr. T. really liked. Once I figured out that what he really wanted was for me to stop giving him gifts, I gave him that. No gifts. I figured you’d feel the same way, so I’ve been giving you the gift of no gifts, too.”
I felt my eyes tear up. I will miss her. Who says that doctors don’t love their patients?
“What about taking care of yourself? What about your pain?”
Pearl smiled. “I’ll be okay. I’m on oxygen now. As long as I’m taking care of my sister and other people, I’m good.”
Information & Authors
Information
Published In
History
Published online: 19 November 2024
Keywords
Authors
Metrics & Citations
Metrics
Citations
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
View Options
View options
PDF/EPUB
View PDF/EPUBLogin options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).