We pulled into the driveway through an arch of vining plants, revealing a small white house on a large lot of land. Lake Huron stretched across the horizon.

I was on a week-long geriatrics outreach trip with Dr. Dana Trafford, Resident Alum (Internal Medicine, 2019), travelling between Blind River and Manitoulin Island. Many of the patients we met were navigating cognitive impairment, falls and frailty while living hours from specialized care.

That afternoon was my last day at Little Current Hospital. The patient we were visiting had advanced Parkinson's disease and dementia. She had missed her appointment because her husband could not physically get her out for the drive across the island. So the nurse and I hopped in the car.

The couple was in their 80s. We could immediately see evidence of the life they had built for themselves over the years – the windchimes dangling from old trees, little paw prints pressed into the mud, worn-out rubber boots on the porch and a stacked log pile near the house.

Her husband had arranged her pill bottles neatly across the kitchen table before we arrived. He described her routines with dutiful detail.

I could tell she had likely started her medications years earlier and had not been able to find someone to help her adjust them as her disease progressed. Her symptoms were now significantly under-treated, making it very difficult for her to move.

At one point during my physical exam, she became quite tired and jokingly collapsed into their large, floral couch. Her husband laid his head on her shoulder, chuckling alongside her.

As we talked about the future, he spoke plainly about what was coming. He knew she was nearing the end of her life. Still, he was determined to keep her at home.

While we were speaking, she began pulling at her hair. I worried that she was becoming agitated. But he understood she wanted it braided.

Braiding her hair, he admitted he was afraid of being so far away from her, since the long-term care home was quite a distance. How would anyone know what she needed in moments like this?

He understood her without her having to explain.

“The image of this couple on their couch stays with me. Both exhausted by disease, yet still making room for tender moments, however small. I think of them, and the many others who simply wish to go on living their lives at home.”

— Dr. Vithusha Ganesh