Promises Kept - 3

On my initial encounter with Mr. X and Mrs. X, it was apparent that there was a significant difference in their ages. Mr. X was a well-groomed soft-spoken, white-haired gentleman in his early eighties, Mrs. X appeared to be about thirty years younger, tastefully attired, attractive and very attentive to her husband. They had been referred to me by her gynecologist because of her concern that he, Mr. X, was losing memory.

After a lengthy discussion of his declining state, I examined him and was taken with his astuteness and genuine concern for his health. In the examining room, while his wife was in the waiting room, he confided in me.

"Doc, you can see the difference in age between myself and my wife. I want you to know that she and I have been married for six years now and they've been the best years of my life. We have a wonderful relationship and she truly cares for me. In all honesty, there have been issues with my two sons who think she is a gold-digger and that she married me for my money, but I believe that the inheritance is the only thing that interests them. She is my life."

As part of the examination, among other more routine blood tests, I sent a special test for tertiary lues. If one has syphilis and it is not properly treated it can become seated in the brain and cause a decline in cognitive function referred to medically as tertiary lues. It can take many years to become apparent but, because of X's service in the U.S, army in Europe in WW1 before penicillin was available, I included the test in his assessment. It came back positive.

Aware that X still had good judgement, and because of the sensitivity of the diagnosis, I contacted him and invited him to come alone to discuss his test results. As part of our discussion, I told him that it was worthwhile receiving a course of very high dose penicillin but advised him that it might not halt the progression of the disease. Once more he confided in me that because of his prominent position in an international organization, he did not want the diagnosis to be disclosed.

Over the next several years his mental function declined. Through all those years, his wife was constantly at his side as both his caregiver and as his devoted wife. I never heard from or about his sons.

Shortly after his passing, I received a court subpoena for his medical records. His sons were suing for control of his estate which had been bequeathed in its entirety to his wife. It was clear to me that if the records became central to the court case that the cause of X's decline would become public knowledge. I remembered my promise of several years earlier.

In response to the subpoena, I invited the lawyers who represented his sons to visit me in my office. At that meeting I indicated to them in no uncertain terms that if they did not withdraw the subpoena the records would be released to the court but at the time of trial, when it came to introducing them into the record, they would have a very hostile witness on the stand.

I suggested to the sons that Mrs. X would be amenable to some compromise with regards their inheriting some of their father's estate but that fighting for more in court would work to their detriment. I indicated that I had made a commitment to their father which I very much wanted to uphold.

The case was settled out of court. The promise had been kept.