In Practice: A patient’s tragic secret

“There’s something I’ve never told you.”

We were in the middle of a follow-up exam — my patient in a gown on the exam table, I with a stethoscope in my hand — when she chose to reveal something she had kept to herself for the nearly 20 years of our doctor-patient relationship.

She had come into my office with an acute asthma attack a week ago without an appointment. I had been treating her for asthma for two decades and had seen her regularly, never before with an emergency.

At the time, I knew from the look of fear in her eyes that she had to be seen. She and her daughter, who accompanied her, had apologized for coming without any appointment but said that her breathing had become very labored and that they did not know what to do.

I had taken my patient and her daughter, whom I had never met, into an exam room. She had told me that she had developed shortness of breath in the last 48 hours despite taking her regular asthma medication. She was breathing rapidly, and I noted that she looked all of her 82 years. I had listened to her chest and found wheezing, a sign of constriction of the lungs’ airways.

After that exam, we had sat in my office and I again noticed how frail my patient had become. I prescribed corticosteroids for the asthma exacerbation in addition to her regular medication and asked her to return in one week.

It was on her return visit that my patient — her breathing now comfortable — uttered her statement. We started talking, first about how she felt and then about her emergency visit a week earlier. She told me she had felt as if she had been taking her last breath. She joked that someday she would face the end of her life, but she hoped it wasn’t now. I could see that death was on her mind and told her that her breathing was much improved — and that she likely had many years of life left.

I also said that I enjoyed meeting her daughter and asked if there were grandchildren. She said yes, that they were a joy to her. Then she paused, her face turned solemn, and she said those words that still resonate.

“There’s something I’ve never told you.”

Puzzled, I braced for the answer to her secret.

“My oldest daughter was murdered …”

The young woman had been returning from school when she was shot only a block from home; the slaying was blamed on an alleged serial killer, later convicted in the slaying. She had been 19, beautiful, an honor student. And her mother had never recovered. She had not been truly happy, she said, ever since.

“I love my other children and their children, but this is always in my heart and mind,” she confided. “It never leaves me.”

I told her that I too had lost loved ones in my family and that I understood, to some degree, her suffering. We talked more about grief and life.

As she left my office, I wondered if this might be the last time I would see her. Her asthma had improved, but I sensed something more. When she was gone, I was still unsure about why she had wanted me to know about a devastating personal tragedy more than 30 years ago. That night I could not help searching the Internet for the victims of the killer. They were not hard to find, and, among them, I found a picture of a lovely dark-haired girl whom I thought could have been my patient at 19. As I stared at the image, I realized that I had my answer.

My patient’s thoughts of dying had raised fear that her daughter’s memory would die with her. By telling me her secret, it had become my own. The memory would live on.

I printed the photograph. It was now mine to keep.

Adams is a pulmonologist in New York City and the author of “The Asthma Sourcebook” and “Healing Through Empathy.”

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