The service has slowed down a bit. When one of our members goes on vacation in a few days, leaving me twice the work, things are scheduled to speed up. I love how that works out. I’m sure it happens whenever I go on vacation, too. That’s why I feel guilty about being away even for one day. Something invariably happens when the team has fewer working members.
There was a lady last week who absolutely drove me crazy. I’m sorry to report this, since she was quite nice, and so was her son. But somehow they were terribly aggravating to talk to. All her previous care had been at an outlying hospital, so we had minimal records. The conversation went something like this:
Me: “Well, ma’am, since you’ve been admitted with a probable pneumonia, do you have any coughing?”
[and please don't ask me what pneumonia was doing on our surgery service; my attending loves his patients, what can I say? or maybe he just wanted to increase our skill in internal medicine, since this lady seemed to be a walking textbook]
Patient: “What’s that? I don’t hear so good these days.”
Me: repeat three times, enunciating till I feel absurd
Patient: “Oh no, I’m not nauseated at all. In fact, I’ve been eating real good lately.”
Son (yelling): “No, mom, she said, are you coughing?”
Patient: “Oh no, not coughing at all; just my usual, you know, every now and then.”
Some time later, having established that she coughs about five times a day for the last year, not really productive, certainly no blood in it, we’re on to the next topic.
Me: “You’re not coughing, but are you having a fever at all?”
Patient: “Oh yes, I burp a lot. Do you know anything that could fix that?”
Son (yelling): “No, mom, she said, do you have a fever? No, doc, she hasn’t had a fever.”
Patient: “Except for that time, my temperature was up to 100.8. Does that count as a fever?”
Son: “She means last December. Mom, that was when you had the UTI. The doctor means right now.”
Patient: “Oh, no, no fever now.”
A good while later, having established a complete lack of symptomatology, I proceeded to get a past medical history.
Me: “Do you have any medical problems, ma’am?”
Patient: “Oh, no, quite healthy, dear, quite healthy.”
Son: “Mom, you have cancer.”
Patient: “Oh, yes, I do have cancer. It was diagnosed last summer. You see, my legs were feeling a bit swollen, so after my husband and I went on our usual vacation to South Carolina – we go to South Carolina every year. Charleston is such a beautiful city. Anyway, I went to see my family doctor, and he was concerned that I might have a blood clot or something, so – “
Son: “Mom, she wants to know about what’s going on right now. Tell her about your pacemaker.”
Patient: “Oh, yes, I have a pacemaker, and my heart is doing great, I just got it checked last month.”
Me (sensing a disappearing glimmer of light): “And why did you have the pacemaker put in?”
Patient: “Oh, my heart went a little fast.”
Me: “Was it irregular at all? [to the son] Did she have atrial fibrillation? Do you remember ever hearing that name?”
Patient and son together: “Oh no, not irregular at all. Just fast.”
A long time later, having elicited a medical history containing a disorder in every single organ system, I asked for a list of medications.
Patient: “Don’t you have them in the computer?”
Son: “I don’t have a list, but I know them by heart. Not the dosages, though. She takes lasix, aspirin, coumadin – “
Me: “Coumadin? Why does she take that?”
Son (with great patience): “It’s a blood thinner. She takes it to thin her blood.”
Me: “But why is she taking a blood thinner?”
Son: “I have no idea.”
Me: “She must have atrial fibrillation. Isn’t that right, ma’am? You have atrial fibrillation?”
Patient: “Oh yes, but it’s been just fine since they put the pacemaker in.”
That was the longest surgical history and physical I’ve done since I was a medical student. Apparently lately all my patients have been either coherent, or so demented that their children were obliged to be intelligible. I’d forgotten what it was like to have a patient too alert to ignore, but too forgetful to be helpful.
Much later, the chief came by to check on her. As he wound up his explanation of our plans and headed for the door, the patient smiled at me from the bed and inquired, in an unconcerned voice, “So then they think it will need surgery?” Since under no circumstances would we do surgery for pneumonia, nor could I imagine what we had said to lead her to that conclusion, I threw a wild glance at the son. “I’m sorry, I have to run, could you please explain it to her?” And dashed ignominiously out to keep up with the chief, who was escaping to see our ICU patients.