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A Piece of My Mind
January 2, 2018

The Envelope

Author Affiliations
  • 1Penn Medicine, Woodbury Heights, New Jersey
JAMA. 2018;319(1):23. doi:10.1001/jama.2017.19273

When I move to shake hands with Jack, a 70-year-old new patient and my last of the morning, I see the large white envelope. Records, most likely. Perhaps because of noticing the way he clings to it, or perceiving his urgency, I interrupt my usual routine of logging on to the computer and preparing the history template.

“Is that something you would like me to see?” I ask, eyeing the envelope. He hands it to me, looking relieved.

“He was a great kid, my only son,” Jack says with a soft and shaky voice, as I pull out the stack of papers. On top, I see a newspaper obituary from two years ago with a photo of a smiling young man, David. I read the first line, “age 32, dies peacefully after an extremely brave battle with cancer.…” Jack goes on to tell me about David’s tragically short life, his many accomplishments, their favorite things to do as father and son and as a family. His eyes brighten as he shares these memories with me, but then begin to sink as he recounts the sudden weight loss, blood tests, x-rays, biopsies, and consultations. His gaze drifts toward the floor when he describes the chemotherapy, the hospitalizations, the pain—and then his voice trails off. When he looks up, I see his tears. I tell him how sorry I am for his loss. I think of my own wife and son.