Jeffrey Millstein is an internist, writer and educator, and serves as a Regional Medical Director for Penn Primary Care.
In his essay “Last Call” (Intima, Fall 2023), nephrologist-author Joseph Zarconi confronts the complex issue of crossing implicit social boundaries in the clinician-patient relationship. Ultimately, he decides to accept an invitation to visit the home of Mr. Petruccelli and enjoy a taste of his dying patient’s prized bottle of fabled Johnny Walker Blue. This was a coda to a meaningful connection nurtured over many years, enhanced by a shared passion for scotch whiskey. In my own fictional story “Good-Bye” (Intima, Spring 2024) nurse Kate Porter, mistaken for her dying hospital patient Mr. Curtin’s daughter Alex, also crosses a boundary when she assumes this role, acquiescing to his final hug and declaration of love. In their own way, they are both gestures of compassion and kindness despite breaking social norms.
In both cases, the care providers are compelled to share their stories: Zarconi by way of his personal narrative essay and the fictional Kate who plans to tell her husband of her experience. The storytellers have also created opportunities for some healing of their own. Kate plans to use her story to rekindle some lost closeness with her husband, whom she has been inundating with negativity from work. I imagine that in composing and sharing his own personal narrative, Zarconi has created a path to work through any remaining ambivalence about his relationship with Mr. Petruccelli as well.
Both stories take readers into the “gray zone” of social convention in medicine that exists between ethical extremes. Navigating the gray zone requires deeply rooted empathy and selflessness enough to allow one to consider accepting significant emotional unease in order to comfort another person. Stories told and heard are an important way to process these forays into morally ambiguous spaces that medicine has a way of pulling us into without warning. Zarconi and Kate Porter provide thought-provoking examples for us all.
Jeffrey Millstein is an internist, writer and educator, and serves as a Regional Medical Director for Penn Primary Care. He is a pre-clinical instructor-mentor and serves as an office-based clinical preceptor for students at the Perelman School of Medicine at the University of Pennsylvania. His essays have been published in JAMA, The Journal of Patient Experience, Journal of General Internal Medicine, Intima: A Journal of Narrative Medicine, and Family Medicine. He is also a frequent op-ed contributor to The Philadelphia Inquirer. His short story, “Good-Bye” appears in the Spring 2024 issue of Intima: A Journal of Narrative Medicine.