Giving Up

Saturday, September 12, 2009

Last week I crossed paths again with a patient I've written about before. She was in our office for her weekly coumadin (blood thinner) check and was still in a relatively poor mood, even though the doctor put her on 50mg's of Zoloft approximately six weeks ago.

I cannot recall the list of her diagnoses, because it's long, but I can tell you that she has a PEG (percutaneous endoscopic gastrostomy) tube that is used to feed her. (This random picture, downloaded from the web, is what it looks like.)

My particular patient is in her 70's, weighs approximately 90 pounds, has a terrible odor about her and is not very nice to be around. Were it not for her husband and daughter at this visit she would have been unbearable. In short, she thinks everybody thinks she's crazy, and what we've learned about her, even though she has valid health reasons, is that she is a drug seeker. Her husband alerted me to this fact when he recounted a recent event of her attempt to overdose on sleeping pills.

During her most recent visit she was complaining about pain around her PEG tube and asked the doctor to look at it. After the female doctor and I gloved up, she started to gently remove the neat dressing covering it. (Later the doctor and I shared the same thoughts that we had expected it to be a pus-filled, open sore because of her unfortunate odor.)

What we found astonished both of us and is a HUGE testament to how well the patient's husband takes care of her. The entry point of and around her PEG tub was meticulous. Not even a hint red skin that would indicate an infection. Were it not for the PEG tub exiting her belly, her skin looked like that of a baby. It was amazing!

What we also know is that this patient has completely given up and would rather die than continue living in this condition.

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One of my most favorite patients is an 80-something year old female, diabetic, coumadin dependent, and is showing signs of dementia.

When I started my externship at this facility ten months ago, she was able to walk. Now, due to severe edema of her lower extremities, she is pretty much confined to a wheelchair. In addition to the severe swelling in her legs, she also has a large open sore on her left shin and other smaller, not quite as bad, bedsores.

At her recent visit the doctor requested chest x-Rays and we had to do them while she sat in her wheelchair because she is not able to stand for more than a few seconds.

While a co-worker finished the x-Rays I stopped by the patient's room to talk to her daughter, a very sweet lady who brings her mother to every appointment.

I could tell by the look on her face how weary she was and, perhaps, in need of someone to talk to so I opened the dialogue by asking her how she was doing. As the tears welled up in her eyes she explained to me how her father deteriorated in the same way as her mother is and that five years ago on Christmas eve, he passed away.

She went on to tell me that on the day they were burying her father, one of our doctor's called to tell her that all of her dad's blood tests were normal.

The daughter also admitted that, as much as she doesn't want to lose her mother, she knows she won't get any better because her mother, too, has just given up.

Hit the Floor

Saturday, September 5, 2009

A recent patient encountered a series of unfortunate events as she prepared to leave her home for our office.

Shutting her electric garage door from inside it, she decided to do something many people have done ~ quite successfully I might add ~ run underneath it to the outside world.

Instead of flying unscathed underneath the closing door, it hit her on the forehead (causing a bruise and slight abrasion), which knocked her to the floor (giving her a knot on the back of her head).

I wouldn't have dared laugh during her intake if she weren't already laughing hysterically at herself. Honest!

15 Years

Patient: "I figure I have another 15 good years left."

CMA: "You have more than that."

Patient: "My family only lives to 80."

CMA: "You'll be the first to beat them."

Patient: "One did, but she didn't know who she was. I want to know who I am when I die!"

How to Save a Life

On Wednesday, September 2nd, I put to use a skill I learned through lecture, book work and a few (pretend) practice moves.

The Heimlich Maneuver.

As a rule, when lunchtime rolls around at the office, I prefer to leave the building and eat lunch elsewhere. I am a firm believer in the change of scenery doing a body good and I even take it to a higher degree by walking around one of the two large chain department stores nearby.

On Wednesday, however, I changed my routine. Although I left the building with the intention of having lunch outside of it, I wound up buying my lunch and returning to the office to eat it in our break room.

Initially I was eating lunch with three co-workers; two front desk staff and another Medical Assistant but we were soon joined by one of seven physicians in our practice. She, too, had purchased her lunch and brought it back to the break room to eat it.

As we talked about this and that ~ complete with laughing and giggling ~ the physician, who was sitting next to me, made what the rest of us thought was a laughing-with-soda-coming-out-of-her-nose kind of sound.

Grasping at her neck, we very quickly learned she was in serious trouble with something lodged in her throat.

As Dr. H scrambled toward the wastebasket and started wildly grabbing for the door to open it, I jumped up from my seat, wrapped my arms around her middle and gave her two quick thrusts dislodging the object (a piece of chicken) from her throat and onto the floor. (Later the Office Manager would describe it as a "text book" Heimlich.)

After the crisis was over the five of us returned to the table in an effort to resume eating our respective lunches. Sitting next to each other again, Dr. H quietly picked at her food as we glanced at each other several times. Neither one of us could believe what just occurred but we tried to make small talk anyway. Rubbing my arm, and in between quiet coughs, she thanked me for my help.

I was still overwhelmingly stunned, and the massive adrenaline rush was still flying through my body at warp speed, and I sat there with my body visibly shaking. I shook the rest of the day.

Soon, lunch ended and we were back to the craziness of another busy day. Every time Dr. H and I were near each other that afternoon, a look passed between us that spoke volumes without a word being said.

Once, she hugged me tightly and thanked me again saying she would like to take me out to lunch. I told her that that wasn't necessary and that although I preferred she didn't do that (choke) again, I had her back if she did.

Another life saved.