Monday, February 05, 2007

Favorite Patients

I currently have 3 of my favorite patients ever:

#1: 75 year old Hispanic lady, advanced Alzheimer's dementia. She came in from a nursing home with no information, a raging UTI, and horrible decubitus ulcers on her feet (which made me angry). She doesn't speak, and can do nothing to care for herself.

What I like about her are her eyes. She has beautiful dark brown eyes, and they are very expressive. When I come in and speak to her in Spanish, she looks at me, and I can see her facial muscles twitching, as if she'd like to say hola. She can nod or shake her head in response to questions. Perhaps it's all my imagination, but I don't care. I call her "abuela" and try to take good care of her, and look forward to seeing her look a little better every day.

#2: 75 year old white lady, quadriplegic for over 20 years. She came in with a UTI and pneumonia. She gets around in a motorized wheelchair, as her right arm is about all she can move; she is otherwise dependent on a caretaker, but lives alone. She's also active in her church, takes her grandkids to Target on the weekends, and is a political activist for the disabled.

When I came to see her, she had a fever, and had so many blankets piled on top of herself that all I could see was a small black knitted hat sticking out. The whole pile was quivering (she had chills). Her fingernails and toenails were painted shiny pink, and she had eyeliner on (she'd been at a church meeting in the morning). Her daughter spent the night in the empty bed next to her mother's, and when she left in the morning to go to work, another family member took her place.

#3: 80 year old African American lady, PMH of diabetes, HTN, heart attack, coronary bypass, coronary stents, CHF, cholecystectomy, cataracts, dyslipidemia, and breast cancer 20+ years ago. Amazingly, she lives alone, cooking, cleaning, grocery shopping, even driving for herself. She'd taken her oral hypoglycemic agents faithfully for years, including last week when she had gastroenteritis and wasn't eating much. When her family went to see her Saturday morning, she had two black eyes and didn't know how she'd gotten them. They left, but returned quickly when they couldn't reach her by phone. They broke down the door to find her sleeping in bed, unarousable. EMS found a glucose of 21, so they shot her full of dextrose, she woke up, and they brought her to us.

She had two vivid black eyes, a cut on her nose, and a goose egg on her forehead. Her chief complaint? "I don't know." She was too cute. She kept touching her forehead, amazed at how tender it was. She just couldn't figure out how her sugar had gotten that low. Her fingernails and toenails were also painted pink.

I've had other patients whom I've greatly enjoyed meeting. There was a little old lady at [county hospital] who had metastatic cancer to her lungs. Her doctors had quit chemotherapy a few weeks prior. She came in with pneumonia. We got to talking, and she was only a few weeks younger than my grandmother. We talked about her grandchildren, and her life. She told me she was ready to sign the DNR, because while she didn't want to die, if it was her time, it was time to go. She'd had a long, happy life, full of love. We fixed her pneumonia and sent her back home with her daughter. She was so peaceful and happy, even with all her pain, that it helped heal something in me.

I loved the newborn babies. I loved the 4 week old African American baby with fever whose proud papa dressed him in a black Nike onesie and matching cap. I loved the Hispanic baby who grinned toothlessly at us every time we approached.

It's so easy for me to get distracted by the sad stuff. In peds, the sad stuff outweighed the happiness. On neuro, it was almost all sad--neurological disease is devastating, and we can do so little to cure. In general, we do so little to cure in all of medicine, which is one reason I'm attracted to surgery. I like the idea of fixing things, not just tweaking long-term meds. I probably ruined myself for internal medicine by reading House of God before medical school, but so little has changed in the 30 years since it was written that it's amazing and depressing all at the same time.

At least there are high points.

No comments: