The superfluous, a very necessary thing. --voltaire
It was Friday before the holiday weekend. The staff had been working hard to finish so that the office could close early enough to give everybody a chance to get out for last minute Christmas shopping.
My last patient of the day, my last patient of the week, turned out to be a kind, soft-spoken, elderly gentleman who had been my patient for many years. He waited patiently for me in the exam room.
I picked up his chart and looked at the nurse's notes. It read simply, "infected cyst." He lifted his shirt to reveal a nasty infected sebaceous cyst, fluctuant, tense, pointing, surrounded by cellulitis and painfully tender.
I sighed. I glanced at the clock and then at his chart. He is an insulin requiring Type II diabetic and is ninety-seven years old. Today is his birthday.
"Happy birthday Mr. Grey. How long have you had this?"
"When you get to be my age birthdays don't matter much anymore. I have been hoping it would get better on its own."
Mr. Grey's abscess was incised and drained of its foul putrid puss. The remnants of the sebaceous cyst were cleaned out. The empty cavity was loosely packed with iodoform gauze and an antibiotic and analgesic were prescribed for the cellulitis. Cultures were sent to the lab. Mr. Grey was sent on his way to salvage what was left of his ninety-seventh birthday. Arrangements were made for me to meet him at the office on Saturday to repack the cavity.
So began three brief encounters between four individuals over the coming three-day holiday weekend. My daughter, a third year Vet student, home for Christmas, was my companion and assistant for the dressing changes. Mr. Grey's out-of-town daughter was home for Christmas as well. She served as his chauffer and companion on their trips to the office.
For three days, including Christmas Day, the four of us met at the back door of my office at a predetermined time. I unlocked the door and we went inside to go through our little ritual of the abscess dressing change together.
We four got to know each other a little, to share each other's lives together a little and to just care for each other a little. It wasn't a big deal; it wasn't anything anyone planned. It just happened. It was just something that needed doing.
When Mr. Grey's daughter first met my daughter she asked, "Are you the nurse?" My daughter said, "No, I'm a Vet student." I said, "She's studying to be a doctor. Another doctor in the family." I guess I'm proud about that.
Driving home we had this great discussion about the inflammatory response, wound healing, healing by secondary intention and I'm thinking, "What a great conversation to be having with my daughter."
It was a great Christmas.