Category Archives: seniors

Everyone Did Their Part, But

–Therese Zink

Late in the afternoon, the effects of my midafternoon cup of coffee were dwindling. I picked up the chart of a new patient with the chief complaint, “Needs a home health nurse.” He sounded like a good patient for Melissa, the nurse practitioner student who was working with me, to see and sort through the
concerns. In the meantime, I saw two other patients.

Melissa emerged from the exam room. “You better sit down for this one.”

“Be as concise as you can,” I said as calmly as I could.

The patient, eighty-seven years old, had not seen a doctor for twenty-five
years. Retired from farming, Mr. Gains and his wife lived alone in a farmhouse
outside of town. Their son worked the land, and their daughter ran the dry
cleaning store in town, just minutes away. The daughter said she cared for them
twenty-four hours a day, made their meals, bathed them, everything. It was
getting to be too much. Two days ago, her father quit walking and eating. Her
mother used a walker. They needed someone to come in and help.

Melissa and I entered the exam room. The daughter, a middle-aged bottle
blonde, who was generous with her makeup, rose from her chair. I introduced
myself and told her that Melissa had filled me in. “What’s your main concern?”
I asked.

“It’s getting to be too much. I need some help. I thought maybe a nurse once
a week,” she said as she moved toward the door.
Mr. Gains was frail, wearing a feed cap and overalls. When I addressed him,
he made eye contact but didn’t say much. We learned that he spent most of
the day in a reclining chair, that he was usually incontinent at night. He never
had much of an appetite. Both the daughter and son checked on the couple
throughout the day.

“Dad doesn’t have insurance, so my brother doesn’t want much done,” the
daughter said tapping her toe on the linoleum floor.

“But he’s over sixty-five. He should have Medicare,” I said.

“Neither of my parents have it.”

Strange, I thought, and asked the daughter to step out of the room while
Melissa and I did an exam. She was reluctant to do so, so I walked her down
the hall and reassured her that we would bring her in as soon as we were done.

“Please, they don’t have much money,” she told me.

I reiterated that we would do the best we could.

When I returned to the room, Melissa had helped Mr. Gains onto the exam
table, which was low to the floor, making it easier for elderly patients.
“Pretty unsteady on your feet, aren’t you Mr. Gains,” Melissa said.

“Do you hurt anywhere?” I asked.

Mr. Gains shook his head.

I asked the usual questions about vomiting, fever, chills, diarrhea. . . . Mr.

Gains denied all. Finally, I inquired, “Is anyone hurting you?”
Again, Mr. Gains shook his head. As we removed his flannel shirt, I noticed
a layer of brown oily scum around his neck and under his arms. His odor was
pungent, not like urine, but similar to that of overripe fruit. His T-shirt was
gray. His lungs were clear, and his heart rhythm was regular. No murmurs.
We removed his overalls; they were clean, as were his undershorts. The brown
scum was also accumulated at his beltline and in his groin. Melissa removed
his threadbare socks. Near his ankles were two quarter-sized bedsores.

(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

As health care professionals–nurses, doctors and social workers– we are mandated reporters of suspected abuse for adults in most states and for child abuse in all states. These are always difficult situations. This one was particularly complicated.  Read the rest of the story. When I talk to students about managing families who are living with abuse, I always remind them that as a physician it is not my job to decide who is right or wrong, but to link the family with support and the people who can make that decision.

 

Home Visit–sometimes your patient makes you laugh

The Brothers

–Ann Neuser Lederer

I go to visit two brothers,

one eighty-eight, the other past ninety.

Scoured and shaved and smiling for the nurse.

Shoes shined, pants pressed and belted,

plaid shirts buttoned to the neck.

Past ninety takes his teeth out

when I ask to look in his mouth,

then he goes to bite me.

Both brothers chuckle.

This morning, says the young one,

he told his brother

while changing the diaper:

You’re just like an old cow now.

I have to clean out your stall.

The brothers laughed and laughed.

The older brother adds:

My brother’s a funny guy.

He don’t say much,

but then

he comes out with something.

 (Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

It is important to like what you do. Some days are drudgery, that’s life, but most days your work should make you happy.  If not, reconsider what you are doing.  It’s important to take the time to find the delights–the experiences in your day that make you smile.  Nurse Ann Lederer shares a home visit poem with us about two brothers.  Watch Ann Lederer read her poem.

Home Visit

As a medical student in North Carolina, Dr. Fleg did a home visit with his preceptor and received a gift for his heart.

 The Sisters

–Written in Love

by Anthony Fleg

My watch said it was time to go,

But my heart spoke otherwise,

Fortunately, I listened to the latter

And went with Dr. Stuart to see

The Sisters

Miss Minnie and Miss Viola

Hailing from Georgia,

With ten scores of wisdom between them,

They spoke first, without words

Perfuming the room as we entered.

They began to tell of their aches and pains,

Joking about whether Dr. Stuart or I would be their “catch” for the day

When asked about the key to their longevity,

Viola answered, “God has been good to us,”

While their relative with them offered, “It is because they were good to their momma.”

Which caused me to pause,

Trying to shut off that medicalized, left-brain-oriented way of hearing that afflicts many of us in medicine,

They spoke not on the recipe for reaching the holy feat of triple digits,

But instead on the way to appreciate each and every day whole-ly,

as something holy,

They teach that the goal is not to reach an old age

But instead is about how to be on your way there

They remind us that the goal is not to avoid death

But to fully embrace life

I am thankful,

I am refreshed,

Dr. Stuart and I leave smiling with our minds and hearts

If someone asks me why I am late

I’ll simply say, “My teachers had something I needed to hear.”

(used with permission and published in The Country Doctor Revisited, KSU, 2010)

Many patients have lots to teach us, especially older patients, who know their bodies and themselves pretty well. One of my favorite elderly patients, a retired farmer, cannot do much on the farm now that he’s reached 90, but he takes great pride in growing tomatoes. He’s given me many pointers and improved my green thumb. Despite the pressure of seeing lots of patients, Dr. Fleg reminds us that we need to take the time to listen and connect with patients on topics beyond their health and diseases. These kinds of connections nourish us and are the rewards that come from taking care of people. If we don’t take time to bask in these, we will get burned out and cynical. What are some of the treasures you’ve heard and witnessed on your rural rotation? What wisdom will you carry with you for a while? Urban patients have many treasures to share as well. Urban or rural, have you seen interactions between your teacher and a patient that remind you of Dr. Fleg’s. Sometimes you are working with teachers who are burned out. What opportunities to interact with patients have they missed?