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.