Diagnosis: Loneliness by Nathan Riley, MD

Ms. P was recently given a challenging diagnosis: loneliness.

Our home-based palliative care team has been seeing her for nearly a year. Since then, we have helped her navigate the turbulent waters of a cancer diagnosis. At our routine visits, we address the severe and complex pain resulting from the widely metastatic breast cancer that will take her life. She has anxiety, difficulty sleeping, and innumerable worries about being able to accomplish what’s needed daily.

We’ve worked hard and effectively to ensure that her medications are refilled, even when it required a staff member to sit through hours of monotonous hold music with pharmacies and insurers, triple checking that her low-income housing paperwork won’t lapse, and being tenacious in making sure that the communication between her oncology program, primary care practice, and our team is seamless. 

Today, Loraine Wilder, RN, her Palliative Care nurse went to see her, prepared to take on the task of reviewing her medications for the bajillionth time. With all of our  continuous efforts to meet Ms. P’s medical, spiritual, and social needs on a weekly basis, Ms. P seemed … elsewhere.

At first glance, you might think Ms. P was ungrateful. For a low-income patient with a severely life-limiting condition, the Resolution Care Network staff had provided her with the best care possible. So why the long face?

“I need a friend.”

Loraine turned to her abruptly. “A friend?”

“I’m lonely.”

She wasn't asking for an introduction to the local bowling league or to make a new fishing buddy. What she had in mind was companionship. In her home. Somebody–or something–to be with her.


“I’d like a goldfish. I could talk with him. He would keep me company.”
Here we are, at the height of medical technology, yet the experience of being sick remains unchanged over the nearly 40,000 years of human existence. Ms. P undoubtedly values the improvement in her pain and anxiety. She is eternally grateful that she has a team of compassionate people to review her systems and elaborate her goals of care in the safety of her new mobile home, where she enjoys hot showers and hearty meals.


But what she needs most in this time of illness is a friend. In healthcare, we become so myopic in our treatment of pathology, that we often lose sight of the patient behind the curtain. When we take hold of a sick woman’s hand and really listen, your diagnosis might be a little surprising. Indeed, “loneliness” doesn’t come with an ICD-10 code.


With the generosity of a local pet shop and our diligent staff, Ms. P made a friend this month. And while her expensive cancer therapies and complex symptom management will continue as long as she sees value in it, addressing her well-being and her personhood seems to have made the biggest difference of all.

– Nathan Riley, MD
Nathan Riley, MD is the newest physician at ResolutionCare Network. He also happens to be an Obstetrician and likes to write about caring for people from “Womb-to-Tomb”