Last month's Medicine and the Arts column also featured a commentary on the topic of the “difficult patient.”
Lisa Dittrich, senior editor of Academic Medicine, is the editor of “Medicine and the Arts.” (Unsolicited submissions are welcome.)
In these excerpts, farmers Warren and Mary discuss Silas, an errant farm worker who has wandered back to implore them for shelter and employment. Warren and Mary argue about what is owed to Silas; later, they find out that he is gravely ill and has in fact returned to die. Warren speaks first, then Mary.
‘When was I ever anything but kind to him?
But I'll not have the fellow back,’ he said.
‘I told him so last haying, didn't I?
If he left then, I said, that ended it.
What good is he? Who else will harbor him
At his age for the little he can do?
What help he is there's no depending on.
Off he goes always when I need him most.
He thinks he ought to earn a little pay,
Enough at least to buy tobacco with,
So he won't have to beg and be beholden.
‘I know, that's Silas' one accomplishment.
He bundles every forkful in its place,
And tags and numbers it for future reference,
So he can find and easily dislodge it
In the unloading. Silas does that well.
He takes it out in bunches like big birds' nests.
You never see him standing on the hay
He's trying to lift, straining to lift himself.’
‘Warren,’ she said, ‘he has come home to die:
You needn't be afraid he'll leave you this time.’
‘Home,’ he mocked gently.
‘Yes, what else but home?
It all depends on what you mean by home.
Of course he's nothing to us, any more
Than was the hound that came a stranger to us
Out of the woods, worn out upon the trail.’
‘Home is the place where, when you have to go there,
They have to take you in.’
‘I should have called it
Something you somehow haven't to deserve.’
Warren returned—too soon, it seemed to her,
Slipped to her side, caught up her hand and waited.
‘Warren?’ she questioned.
‘Dead,’ was all he answered.