Story of a Gouty Finger

Mr. Adams was admitted yesterday to my floor. He had gone to see the surgeon for a biopsy on the middle finger of  his right hand.  The surgeon also noted that Mr. Adams had swelling of his legs which has been progressing over 2 weeks. Further questioning revealed there is liquid seeping out of his legs and there is a water puddle wherever he sits for a long time. He was admitted to the hospital with the diagnosis of congestive heart failure.

Mr. Adams is 99 years old. He has the far fetched look in his eyes as if these eyes understand the mysteries of this world, and the world far away.

I go to meet him. He has a gentle smile on his face and he speaks in the slow manner of a man who understands that time is a fleeting concept. I look at his legs, they are swollen and the skin has peeled off from one of the legs. They have water seeping out of the skin. His knee joints are deformed and the skin is dry as an old tree trunk.

Mr. Adams used to work for an ad agency. He worked in the PR department and worked in the calligraphy department. He worked on teaching penmanship before the advent of computers. And today, his fingers are swollen. The joints are deformed, the fingers can barely hold a spoon. The gouty protuberances are jutting out from the finger joints.

I look at his far fetched eyes and he has the understanding that nothing in life is permanent. The time is all-powerful and the ever-turning needles on the time clock will steal a lot from us.

 

How Do You Let Go

I have been caring for Mr. Peters for last few days. Mr. Peters is 85 years old. He was living his life when incidently he was found to have lung cancer. He started chemotherapy and radiation which played havoc on his body. One day trying to get out of his bed, he fell and broke his hip.

Of course the surgery was done. But least expected the surgical site got infected. And then began the cycle of hospital admissions, discharge to a rehabilitation facility and readmission to the hospital. This admission, Mr. Peters came with pneumonia, infection in his lungs. We treated him with antibiotics, oral care, fluids and hours of nursing care. Mr. Peters was recovering but then the wound on the leg looked infected and he had to go to the OR for revision. Once again, his fragile body went thru the havoc. He lost blood, his kidney function worsened, his lungs filled up with fluids. With medical care most of the abnormalities were fixed. But over last two weeks his swallowing muscles weakened to the extent that he was not able to handle his secretions.

Today, I see Mr. Peters. Overnight he got sick. His oxygen requirement increased. He likely aspirated on something he was trying to eat.

I meet with his family and him. Mr. Peters tells me he wants to discontinue the care he is getting. He is done living and wants to pull the plug. His wife, his daughter and son and extended family are there. I look at Mr. Peters. His eyes are bright, he is looking at me with authority. And I question myself, how do I let go of Mr. Peters.

We talked to him and I transferred him to ICU with the promise that I will visit him everyday. We all begged him to give us a few days to try to save his life. He agreed. I walked out of the room thinking its so hard for me to face the reality now that I have spend hours with Mr. Peters. I think of his family – how do you let go of someone you love?

The Story Of A Swallowed Pencil

Yesterday in th evening I recieve a call from a nurse. A patient stated she has swallowed a pencil. Given the evening hours, I asked the nurse and to call the Physician Assistant on call.  Today morning, I go to the floor and ask if anything was done for the patient.

Abdominal Xray was done which didn’t show any foreign body. Given the absurdity of tehe complaint, I had an option to believe the patient or not. I decided to believe her and ordered a CT scan of her abdomen. As soon as the CT scan is done,  I’m looking at the films and there is the pencil somewhere stuck in her gastrointestinal track. Jessica, my 22 year old pencil swallowing patient is standing next to me. She is a petite girl with the cutest smile on her face. She looks at me and says – “didn’t I say so and you guys decided almost not to believe me”.

I call the surgeon on call and while waiting for them to answer, I start talking to Jessica. She is afraid and wants the pencil to be taken out as – ” the pencil has a sharp point and will hurt while coming out”.  I look at her amazed – she is so innocent, she has no clue about the complexity of her disease and potential surgery in front of her. On questioning, I asked Jessica why she swallowed a pencil. Her innocent answer – to get attention from the nurses and the staff.

I look through her chart. Jessica grew up with parents around but who were way busy in there own lives. Her dad travelled for work and mom was an alcoholic. She struggled with her self image, she being a petite shy girl. She was always an outcast at school and no one to confide into as a child. Jessica moved out of the house when she turned 18. She was in college for a while, but quit as decided to work and move in with a boyfriend. It’s been one messy relationship after another looking for approval and attention. Last break up leads to this admission to the hospital on the psychiatry floor. And here she is, another messy situation leading to a swallowed pencil.

The surgeons come to the floor and take Jessica to the OR. And I see her getting wheeled over. All the while I’m thinking who is to be blamed for the swallowed pencil??? Is it Jessica or our modern society which has led to so much isolation. Would this behaviour continue or else Jessica will find some way to feel acknowledged in this world.

Triumph of Body Over Mind

Today I discharged Dr. Matthews from the hospital. He was admitted with a viral infection which had settled in his lungs.

Dr. Matthews worked as an ER physician for a long period of time and had retired when the joints in his legs gave up and he couldn’t stand long hours. In the last ten years of his life, he was diagnosed with Heart failure, Diabetes, Spinal Stenosis, and Osteoarthritis –  the diseases of old age.

Dr. Matthews came to the hospital with a viral infection causing his heart to fail and fluid to build up in his lungs. His heart rhythm decided to get erratic – again a sign of aging heart which made the heart failure worse.

He became progressively weak. His mobility decreased and his arthritis worsened. His muscles failed to remember how to swallow food and he started aspirating on thin liquids. Knowing all that was in front of him, Dr. Matthews made a decision to get a feeding tube. He became confined to his bed and wheelchair. Today at the time of his discharge, he was a bundle of flesh, weak legs, protuberant belly, a tube coming out of his stomach and another tube supplying him with oxygen to keep him alive.

In spite of it all, Dr. Matthews stayed sharp as a whip. He managed his care, his diuretic dose, his feeding schedule, and his laxative dosing. He had fights with the providers, he expressed frustration, anger and fear. But finally, the body gave up, the fierce will to survive has vanished. The body seems to be taking over the mind. Its the triumph of a dying body over a sharp mind.

 

 

In The Name Of Love

Rachael appeared sad and dejected. She is 49 years old. She has a broken hip, a torn muscle in her leg, a broken wrist, no medical insurance, no money, and no family to call her own. She had had various surgeries done but has no place to go. She has no home to go to, she can’t go to a shelter as needs ongoing medical care and rehab facilities wouldn’t take her as she has no insurance.

I start taking to Rachael to understand how she reached where she is. Her answer – all this happened in the name of love.

Apparently, Rachael was living with a man for 15 years. She decided not to have kids or pursue a job. As per her, her man left her for a younger woman when he turned 50. She moved back to California to be close to her elderly mother as there was no place to go. She started living with her elderly mom and was working as a waitress. While at work she fell and sustained all these fractures.

We called Rachael’s mom to understand the whole picture. Rachael had moved back home 6 months back. She had not been able to hold a job as she was not used to working for her upkeep. The money she made occasionally was all spent on buying alcohol. The fall happened as Rachael was dead drunk and was having an argument with her mother.

As I walked out of Rachael’s room, I couldn’t help but wonder  – is it all in the name of love? Shouldn’t Rachael have known enough to understand that circumstances change and life changes? Is her boyfriend to be blamed for it all? Or rather the blame lies on Rachael for not having self-sufficiency even at his age?

I don’t know how long Rachael will stay in the hospital and where she will be discharged. And all this while, she sits in her room all angry at her boyfriend and the world around her.

 

 

 

To Be Or Not To Be

Sam was admitted two days back to the hospital. He is on the orthopedist floor. I saw Sam sitting in the chair with a smile on his face. A new face for him, another doctor to see, once again he would have to tell the whole story about his fall.

Sam is hard of hearing, he has two days old beard on his face and he is almost 80 years old. He had the surgery done to have his hip fixed. His left side of the chest still hurts. Sam took a nasty fall and broke his hip and a few ribs.

Thankfully the surgery went well. His broken hip is fixed. He has a long recovery ahead of him. He will be discharged to a rehab facility soon where his mobility will be gradually increased based on his pain tolerance. He still is at risk of developing pneumonia, infection at the site of surgery, or blood clots. Hip fractures are a leading cause of death in the elderly population.

When I see Sam, I ask him the reason for his smile. He mentions – “to be or not to be”. Sam fell as he saw a big nasty yellow bee in his living room. He vividly described the bee. It was yellow with black stripes and big antennas. . Afraid that the bee will bite him, Sam stomped on it. While trying to kill the bee, Sam took the nasty fall leading to the hip and rib fractures!!

This story explained the smile. What would be worse, a sting by the innocent bee or the fall leading to six months of misery with the hope the life will come back to normal.

A Lonely Planet

Amy is a 25-year-old woman. She is 5 feet, 8 inches tall, she has pearly white teeth and thick blonde hair one can only dream of. Seeing her, no one can avoid staring at her. She is beautiful and in a wholesome way. A young beautiful woman.

I met Amy on the psychiatry floor. She is admitted there as she has lost all hopes and wants to kill herself. She has committed herself voluntarily as she is afraid of doing something erratic. I was asked to see her as she was complaining of headache and dizziness. Physical exam was completely normal, her vitals are stable. She is talking in full sentences, but not eye contact and is teary eyed.

Amy has devoted parents, siblings who visit her regularly. Her room is full of get well soon cards. She has fresh flowers in her room, she is wearing fresh clean clothes carefully picked from home instead of hospital-provided medical scrubs.

Amy still feels lonely. She has something deeper missing in her life. She finished her Bachelor’s in Journalism and has a meaningful job.

Why does Amy feel lonely? As she says, she needs a purpose, a definition, a role more meaningful than her current life. She has everything anyone can ask for,  but is that all there is to her life. We are born, we study, we work, we have kids, we get old and we die. To what end eventually? She doesn’t see any purpose behind doing what generations have been doing for ages. She says, this is a lonely planet, where there is not much more to achieve than live the same old mundane life.