“Let’s go.” I was still rubbing sleep from my eyes as my father and I piled into his Pontiac for a housecall. I’d looked at the kitchen clock before we left, 2:30 in the morning. As I have mentioned on other blogs in 1979 as a medical student I was doing an outpatient rotation with my father, a general practitioner, and housecalls were still part of his routine.
We lived in the country but quickly traversed the 6 miles to the town where he practiced. It was a small blue collar town with a large foundry as its primary employer. Rowhomes lined many of the streets and it was onto one of these that we turned. At the far end of the block we could see the flashing lights of the ambulance, beckoning us to arrive as quickly as we could.
Dad had briefed me about the patient on the way to the house. As I don’t remember the names of the family we’ll call them George and Emily. George had been one of my father’s patients for over 20 years and so was quite familiar with George’s health history. He was in his late 60’s with a longstanding history of heart disease. Several heart attacks left him over the years with progressive heart failure and a “cardiac cripple” leading to a poor quality of life. His wife, Emily, had called dad a short time ago asking he come as George was increasingly short of breath.
As we exited the car, dad “popped” the trunk, pulling out his medical bag. Inside were his tools of the trade, stethoscope, otoscope, sphygmomanomter, tongue blades, bandages, tape, analgesics (both oral and injectable), diuretics (oral and injectable), and antibiotics. All neatly compartmentalized and within easy reach. As we climbed the stairs and crossed the small porch to enter the house I noticed a few neighbors on nearby porches looking on. The foyer of the house was neat and tidy while in the background I noticed some areas of drooping wallpaper as well as a couple of religious statues.
Emily had greeted us at the door. Once in the foyer we could hear a commotion coming from upstairs. A rhythmic cadence of, “one, two, three…fifteen, breathe,…one, two…” Emily gave my father some additional information regarding how George had been over the last 1-2 days, sleeping more, ankles more swollen, breathing harder, culminating tonight with George in extremis. We quickly climbed the stairs and entered the master bedroom. George was on the floor undergoing CPR by the two members of ambulance crew. One looked up and recognized my father, “Hey, Doc (to everyone in town he was known as “Doc”), need some help,” as he continued his part of the resuscitative effort. “How long has he been down?” asked Dad. “Weak pulse when we got here, diaphoretic, gasping respirations and then, boom, out like a light. We started CPR right away, working on him for 20-30 minutes but no return of pulse.” With that my father simply said, “That’s enough, boys.” The crew nodded, stopped, and for a final time checked for a pulse that was nonexistent.
Emily had not gone upstairs with us. We descended to the foyer and my Dad offered his condolences and words of comfort. Both Emily and Dad knew that George’s heart failure would ultimately lead to his death and were comfortable with that understanding. As we were leaving, Emily called to my father, “Doc, how much for the housecall (I think his charge was somewhere between $5 and $8)?” Dad waved away her question saying, “I didn’t do anything so not to worry.” Her soft voice’s reply still drifts through my memory, “Sure you did, you cared enough to come.”
This was the only “true” housecall I ever made. Periodically I wonder what would have been different in this day and age. In George’s case summoning of the ambulance would have lead to the resuscitative efforts in the home, establishment of an airway, transport to an emergency room, and ongoing attempts at resuscitation if there had been no family physician to intervene. Would it have made a difference? I don’t know. George had end-stage heart disease known to family and family physician but not the ER docs.
So, excluding concierge physicians who serve only a very small segment of the patient population, a final thought: are “country docs” still making housecalls? Do they still “pop” the trunk to get their medical bags, filled with the basic tools of the trade and a variety of medications? Do they still provide sage advice to family or health care personnel in afterhour situation’s like George’s? Or have they succumbed, like many of us, to advising, “Go to the minute clinic/urgent care/emergency room,” in those afterhour situations?
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