April 30, 2011

halfway across the bridge

I want to tell you a story about a patient I just met. I'm going to tell you his story in his words and then I'm going to tell you his medical story - or rather, his story put to medical language.

Jack* is a 55 yo man who lives nearby with his four grandchildren (ages 4-11) who have lived with him since their mother died and absolutely adore him. He lets the 8 year old paint his nails and do his hair. He does not believe in physically punishing kids, because he wants them to fear consequences, not him. Other family members on the children's father's side have been trying to take the kids away from him ("for a welfare check" he says) by enticing them with toys and vacations, but they choose to stay with him because they adore him.
He was a marine from age 20 to 35, where he trained dogs with a magical touch and met the love of his life. Things were going great until he found out on a random physical (the marines have these pretty often) that he had diabetes and was discharged. In the time that followed, he and his wife raised three daughters and he worked in local construction. After his children moved out, he got divorced - though his wife "is still my best friend" and lives across the street.
After a life of caring for other people but not himself, his body is wrecked from diabetes, both his lower legs have been amputated, and his kidneys are failing so he's on dialysis 4x/week. He's trying to stay positive and take care of the kids, but he's been feeling bored and useless when they're at school. He's trying to volunteer to train dogs, but all 4 places he called told him that his wheelchair is too limiting. When he feels low, he wonders if he should just stop his dialysis and die within 7-10 days.

He comes in today because he has a cough that just won't go away.

Now, the medical story:

55yo white man comes in today with a non-productive cough x 2weeks. It comes on about 5x a day, causes him to gag, and is worse in the morning. He also complains of knee pain where his prostheses connect to his stumps. He is allergic to penicillin and fluorescent dye.
His medical history includes poorly controlled diabetes, resulting in end-stage renal disease for which he is on dialysis 3x weekly and peripheral vascular disease with two amputations which have caused him to ambulate in a wheelchair. He also has congestive heart failure, COPD, depression, and high cholesterol. He takes 14 different medications for his diabetes, cardiac disease, depression, and back pain - including oxycodon. He is a current smoker with 60 pack/years and drinks alcohol occasionally.
He is divorced, unemployed, and lives with his 4 grandchildren (ages4-11) who he has cared for since their mother died 1 year ago.


When I walked into the room to talk with Jack* I was not looking forward to talking with him. I was ready for a grumpy man who clearly didn't care about his health or anything else and was ready to just give up.
But after talking to him, I saw how kind and thoughtful he is, how much he loves his grandchildren, and related to how much he wants to feel useful.
I felt incredibly guilty for how much I misjudged him but feel lucky I had the chance to prove my own snap judgments wrong.

We ended up giving him a prescription for a "therapeutic" dog and adjusting some of his medications to try to help him with his cough. He'll be back in a few weeks to see how it's going.

*obviously not his real name; some other facts have been
altered slightly to protect his anonymity


"you're starting out on the journey across this bridge, this education,
and right now you are on the same side as your patients.
as you get halfway over the bridge, you'll find yourself changing
and the language the patient had and you had
is being replaced by this other language -
the language of medicine -
their personal story is being replaced by the medical story
when you find yourself on the other side of that bridge
you're part of the medical culture.
while you get there,
I want you to hold on to every bit of your old self
your now self
I want you to remember the stories of these patients."

I think that's maybe part of what I'm trying to do with this blog... ?

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