Last Thursday at my off-site visit I was told the man I was about to see was going to be a good patient. A “good” patient? What, a well-behaved patient? A nice patient? A patient with an interesting illness?
Just as I do every week, I explained to my new patient that I was going to do a full and complete history, which was going to involve asking him questions he’s probably already answered about a million times before… and that if he gets tired, he should just let me know and I’d gladly stop bugging him.
So, Mr. X, what brought you to the hospital?
You’ve got to be kidding me! I told you all of this yesterday! I tell you this everyday! I tell you this every time I’m in this damn place!
Occasionally Mr. X, who is hard of hearing, would stop griping at me and yell at the quiet man on the other side of the curtain, his roommate. HEY! Keep it down over there! Quiet down!
After completing his FULL and EXTENSIVE history, I asked him if there was anything I had forgotten. He thought about it for a moment, and said, Ohhh yeah. I have a pacemaker. (So when I asked you if you had any trouble with your heart or heart related problems, you didn’t think to mention that you have a pace-maker, history of A-fib, sick sinus syndrome, AND congestive heart failure?)
Mr. X and I spent a lot of time together that day. I had to hide my surprise when he asked me to check his hair for bugs. Fortunately for us both, I was able to assure him that there were no bugs anywhere. Nevertheless, every step of the way I was confronted with something, oh COME ON!! you don’t really need to know that. I’m going to lift up your shirt now so I can look at your stomach. Do whatever you want already.
Really? You have to know about my family? Yes, Mr. X, I have to take a full family history. He went on to tell me about his children, and then about his grandchildren. He told me he was worried about his wife, who was the only one taking care of him, and who was starting to forget things. He told me he gets depressed being in the hospital so often, and really can’t handle not being able to take care of himself. Which, I realized, is why he wanted me to check his hair. The man is so sick he can’t wash his hair on his own.
When the doctor came back we reviewed a few of the positive findings on his physical. Obviously he kept interrupting us, though this time his tone was markedly different. She did a really good job today, doc.
As I left I thanked Mr. X for being such a good patient.
I wrote the attending an email at the end of last week, informing him I wouldn’t be in this Thursday because of exams. He replied, and told me that Mr. X made the decision to move to hospice care. He realized that because of the severity of his underlying illnesses, things weren’t going to get much better. This 90 year old man who I barely know just made an honorable and good decision, and believe it or not, I feel a bit sad about that.
**As usual, details were changed for privacy reasons.