Prof. Dr. Irany Novah Moraes
Medicine is science and art, like two faces of a single coin; the first is founded on anatomy, physiology, and pathophysiology… the second, on the doctor-patient relationship and on good sense.
Some time ago, when there was still safety in São Paulo and physicians could attend to patients in their homes, I was called by a family of German origin who lived on the outskirts of Santo Amaro.
On arriving, I came upon an elderly man with severe ischemia of the lower limb, downcast, in intense pain at rest, sitting on the bed, embracing his suffering, flexed leg and slowly and gently passing his hand over the cold, pale foot.
The prognosis had been sealed by the family physician, who had proposed amputation at the level of the thigh, while warning the family that the danger to life was imminent and the risk very great.
After a detailed and thorough examination, I gathered the family in the living room, away from the patient, and asked: what do you expect in the face of this situation? For a brief reflection, and on the pretext of washing my hands, I left them alone.
Returning in silence, I awaited the answer. One of the daughters spoke up and said: my father will turn ninety in exactly one month. All of us want to celebrate the date. The first great-grandchild will be born next week; he himself has said several times how much he wished to meet him.
Gangrene was imminent, and his general condition was not of the best. Very weak, dehydrated, malnourished, and at that advanced age! Sharing in the pain of those present, I reflected on the limitations of medicine and, by way of solace, began to tell a story.
Around the early years of the twentieth century, in 1910 to be exact, a physician of German origin but living in New York devised some exercises to improve the circulation of the foot. These exercises gave such good results that they passed into the literature under his name and, to this day, are called "Buerger’s exercises."
Everyone present immediately wanted to know what they involved. I explained that, although very simple to do, they were difficult to perform effectively, for they demanded the sacrifice of the whole family and a great deal of time! With one voice, those present said: we want to do it.
I recommended that they first make a list of everyone who would take part in the program and what times they had available. The list was ready at once and, little by little, the available time slots were being filled in.
The additional explanations and the medications were prescribed and explained one by one, and everyone, each at their own level, understood them clearly.
I began the exercises and personally did them alongside each of those present. I left them doing the exercises and already following the schedule. I visited him periodically, and slowly the patient came to eat without restrictions or complaints, stopped feeling pain, and began to improve.
The birthday arrived; he was well, cheerful, delighted with his great-granddaughter.
At the foot of the bed, speaking very softly, I asked: of all the remedies I had prescribed, in your opinion, which of them do you think was most effective? He paused, thought, and began by apologizing: doctor, you ask me to tell the truth; the fact is that I am certain what cured me, and kept me from disappointing the family, was talking every day or night with all my grandchildren and my children, and knowing how much they love me! Seeing my great-granddaughter brought me great joy!
One night, still at the start of the treatment with you, I dreamed that death had opened the door of my room, and in an instant I saw my whole family gathered and, with all their strength, pushing it out of my room.
I woke with the best of feelings: I would live longer. The love my family devoted to me was extending my time of life. I feel great happiness.
The last news I had of this patient was that the family had already celebrated his ninety-first birthday, and everyone, children, grandchildren, and great-grandchildren, went on seeing him every day.
