Patients are more than multiple choice questions

It felt good to stuff the stethoscope back into my pocket and slip into the emergency department last night. The constant ringing of phones, beeping of cardiac monitors, and distant wail of inbound EMS units was a welcome cacophony compared to the isolated silence of the library study rooms. Sweeping the curtain back as we stepped into the first patient room, the hours of frustration with biochemical pathways and embryological derivatives evaporated.

Li and his father sat side by side on the stretcher, the room’s spare seat having been stolen by another patient’s many visitors. He looked up as I tapped on the wall before entering, but the older man simply stared off into the distance. The triage nurse’s note explained how Li had brought his father to be looked over after he’d spent the past several days roaming the streets, a “Code Silver.” With the Alzheimer’s relentless progression, there were more bad days than good now, and this wasn’t the first time that Li had needed to go searching for his missing dad.

My exam took longer than usual, a combination of rusty skills and academic curiosity, having just wrapped up both the neuroscience and geriatrics blocks. I moved my stethoscope from side to side, intent on not missing the slightest lung crackle or heart thump. “Gas Pedals!” I ordered as I tested muscle strength, felt for pulses, and shined a bright light into sluggish eyes. Even though I knew the resident would repeat the same tasks, I wanted to be sure to cover every base, just in case. It was only after the resident had finished his own exam and the nurse entered to finish her own duties that Li asked us to step outside with him.

He couldn’t do it anymore. He worried that next time he might not be able to find his wayward father, that something bad might happen. Further, with a sluggish economy, rising costs, and a family to feed, Li simply couldn’t afford to continue to miss shifts and take sick days. His father needed better care than Li could provide, and the son needed help placing the aging man in a nursing home that could keep him safe.

It was then that I noticed Li’s fraying collar and faded jeans. The soles of his sneakers were beginning to pull away from their rubber base and a single piece of scotch tape held the bridge of his glasses snugly together. A past-due electric bill peeked from the pocket of his too-large sweater. Li’s struggles and sacrifices were evident in his worn wardrobe.

Some hours later I watched from down the hall as a technician arrived to transfer Li’s father upstairs, the resident having found some tenuous reason to justify admission until a nursing home spot could be found. I returned their goodbye wave and smiled–even as I sighed on the inside, endlessly exasperated with the shortcomings in geriatric medicine that I’ve seen these past years. We have tele-neurology and can call brain specialists from all over the world, yet our grandparents can’t call for help when they’ve fallen. We finance little blue pills and Botox, but struggle to provide a resource to help a struggling man take care of his aging father.

When I got home I collapsed into bed, sending the sleeping cat running away in annoyance. My stolen night in the ER was an important reminder that patients are more than multiple choice questions, and deeper than their disease. This week has six exams packed into five days, and the few hours in the department will help me endure.

Rick Pescatore is a medical student who blogs at Little White Coats.

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