January 2006 | Back to Table of Contents
End Notes
House Calls
By Nancy J. Baker, M.D.
A family physician who carries a black bag carries on a family and medical tradition.
“Doc, thank you for coming,” said the tall, wizened farmer. “Please come in. I see you’ve brought your assistant. Here, have a seat, little lady.”
As a 5-year-old, I had no idea what my father did when he made a house call. One of two general practitioners in our rural Illinois community, he would often be called out in the night to attend to a sick child or elder. What was unusual about this winter’s night was that he had brought me with him. I rested my head on the Formica table and gazed upward at the cracked plaster ceiling. I heard murmurings in the room adjacent and was just about asleep when Dad approached with his large, black doctor’s bag. He reached inside, withdrew a small glass vial labeled in his neat penmanship. He emptied several pills into a small envelope, gave it to the farmer, and explained how often each should be administered.
Shortly thereafter, we walked back to the car. As he reached for the door handle, he looked over his shoulder, waved to our anxious host, and gently told him, “Please call me in the morning if she’s not better.”
Thirty-five years later, I turned to Mike, a family medicine resident seated beside me in the front seat of my car, and asked, “Is this your first home visit? Let’s talk about what might happen.” It was mid December, and we were en route to an apartment on St. Paul’s east side. Three weeks earlier, one of Mike’s patients had had a Caesarian section in order to deliver her seventh child.
“I’d like to check her incision, weigh the baby, ask about breastfeeding, and see how the other children are faring,” Mike said.
As I pulled up to the curb, we spied three small faces pressed to the glass of a first-floor apartment window. I watched these curious children crowd around Mike, begging him to examine them as well. “Me first.” “No, me next.” “Please, can I see that?” The young doctor moved them gently back as he lifted Marvin, the tiny newborn, into his arms. He listened to the infant’s heart and lungs, palpated the small belly, and attempted to shine a bright light into the child’s tightly closed eyes.
“You have a good-looking son,” Mike remarked.
“All my children are good looking,” the serene new mother replied.
We walked into the back room to check her abdominal incision, only to discover that she had no bed. She and her husband slept in sleeping bags in the center of the floor, surrounded by neatly stacked piles of clean clothes.
Mike reminded his patient to bring Marvin to the clinic in one week’s time for his first set of shots. And as we turned to leave, one sibling after another cried out, “I want a shot.” “I want a shot.” “Me, too, I want a shot.”
I’ve done many home visits during my 20-year career as a family physician. I’ve visited frail elders, including a woman with new onset of a heart arrhythmia, a pregnant teen with persistent vomiting, a patient dying of cancer, a young woman eight months pregnant on bed rest because of premature rupture of her membranes, and a 3-day-old newborn going through cocaine withdrawal in an emergency shelter, to name but a few.
For me, this is primary care at its best. I get to see my patients and their families in what is often their most comfortable of surroundings. I find the experience similar to that which I witnessed at the tender age of 5. I’m welcomed eagerly into each patient’s home, I’m often offered something to eat or drink, and I’m always thanked for my services. Like my father, I, too, carry a black doctor’s bag. It contains a few medical instruments as well as equipment to draw blood. Missing, however, are those small vials from which my father dispensed medication with such care. Regardless, I offer my experience, insight, and counsel, and conclude most visits with the same simple advice he offered, Please call me if you’re not better in the morning. MM
Nancy Baker is a clinical associate professor and associate head of the Department of Family Medicine and Community Health at the University of Minnesota who still makes house calls.