"Goodbye Doc"

My colleague told me a great story today from her years of experience. 

An 80 year old spunky female patient of hers had made a sudden appointment to see her.  When Dr. C entered the room, this kind old lady let her know she had taken 3 different buses to get to her appointment.  “And why have you come to see me today?” Dr. C asked.

“I came to tell you good bye.” Dr. C’s brow furrowed, and she waited in silence for more of the story.  “I just know I’m going to die soon. I don’t feel sick, or have any pain…I just know it’s coming.  I’ve pressed my husband’s nicest suit that I want him to wear for the funeral, and I’ve written him a note of the order of service, and now I’ve come to see you."

Dr. C still thought there must be something else to this, and dug deeper into medical symptoms.  She finally got this elder lady to say that perhaps her back was hurting a little more than usual.  In Dr. C’s adeptness she asked another question, “I have a feeling the pain you are feeling is your heart, do you want me to do anything about it?"

To this the patient, well known to Dr. C over the years, replied with a knowing twinkle in her eyes, “No. I know it’s almost time, Dr. C ,I just wanted to come all this way to tell you goodbye, not for you to do anything” 

So, honoring her wishes Dr. C said goodbye, but added, “I’m not going to let you take those 3 buses home!”  Dr. C stepped out and arranged for her medical assistant to drive the patient home – she helped her into the car, cane and all, and hugged goodbye.

The old woman of course died, right in the medical assistant's car on that drive home. Not exactly what the med assistant bargained for in volunteering for the lift home (and as you can guess a little traumatic).

I had to smile at this story, sometimes you just KNOW it's time!

Cynicism in the ER

You get pretty cynical when you work in large ER centers.  Intermixed with the real emergencies, comes a variety of complaints that belong simply with “Ask a Nurse”.  Instead, I am amazed at how long people wait to be seen (often 3-4 hours) to ask about a swollen lip, or a mild case of diarrhea.  It’s 2 in the morning, why in the world would you care about a tick bite right now?!!   But, still they come, for whatever reasons, clogging our hallways and rooms and giving those of us who work shifts in the ER a dismal outlook on humanity’s judgment of the term emergency room. 

The problem is, you can’t let the cynicism encase you.  I was reminded of this last night during one of my weekend ER shifts.  The young woman I came to see said her complaint was “bumps in skin”.  I felt the wheels of “oh brother” starting to turn in my brain.  Still, with utmost respect in my voice I asked about these 2 bumps just noticed that day.  They caused no pain, had no redness surrounding.  One was on her lower belly, about a ½ inch felt just below a small fat layer.  The other, on her back thigh was a similar size, and also soft and movable.  It felt very similar to a lipoma, or small fatty blob we all get sometimes.

I told her they were nothing- internally rolling my eyes, that she had felt this was of such importance that it would be an emergency.  Before I walked away tho, I asked her about the cough she had been exhibiting throughout the exam.  “oh that”, the young 25 year old said, “ I was just diagnosed with cancer last week, it’s in my lungs, but they aren’t sure where it came from, maybe my uterus or cervix”

Just like that, grace abounded.  Her unreasonable medical “emergency” didn’t matter any more.  This poor girl was dying.  I found out she had had a CT scan last week, so went to see if these bumps were there last week.  The blobs were there on the scans, and more likely little cancer mets in her skin than fat collections. I glanced at her xray, showing the diffuse metastatic cancer riddling her lungs.  While still not emergency material, I realized now why this patient was in our ER.  She was afraid. She had cancer spreading and chewing it’s way thru her body, and she had every right to worry about bumps in her skin.

The lesson of course is to give everyone the right for their silly complaints.  I might disagree with how emergent their reason is for walking thru our doors, but I’m still their doctor, and it’s still my job to help heal- even if it’s just respectful reassurance.