How I almost missed a patient’s incredibly powerful story

He was an ornery kind of fellow, evident by his scowl and beady, glaring eyes that greeted me upon my entrance into his room. The nurse, thankfully, had given me a heads-up on this eighty-five year-old gentleman’s demeanor. With her kind warning, I felt prepared to be tested by this patient’s demanding and abrupt nature.

What I wasn’t ready for, though, was this man’s physical appearance. He was extremely small in stature, bordering on petite. His frail elderly body, sitting upright with legs dangling over the cot’s side, contrasted his enormous, palpable presence. As a felt fedora hovered above his round, veiny face and bulbous nose, his feet swayed several feet above the waxed tiled-floor.  His gray-haired wife, equally frail, was sitting quietly in the room’s corner chair, clutching her purse while exuding a warm smile and warmer eyes. They appeared a dichotomy of spirits.

Upon entering the room, I acknowledged this kind woman by nodding and returning her warm greeting. “Hello, ma’am,” I said, “you have a beautiful smile. Thank you for being here today with your husband.”

Next, I turned to the patient to introduce myself. “Hello, sir. My name is Dr. Jim. What can I do to help you today?” I invitingly extended my right hand in greeting.

He did not embrace my hand but rather used his free right hand to point to the gauze dressing wrapped around his left elbow.

He answered in a very thick European accent. “Doctor, I need stitches.”

He offered no further information, but rather continued to gaze steadily at my face. I returned his gaze, hoping my smile would soften his grimace. It didn’t.

After a pause, hoping for more information but receiving none, I continued to interview him. “Sir, could you please tell me what happened that you injured your elbow? Did you fall?”

“I need stitches,” he bluntly replied.

“I understand that, sir, but I just need a little more information about how you hurt your elbow.” Because he was elderly, I needed to make sure a variety of other problems did not accompany his hurt elbow, such as hitting his head, spraining his neck, hurting his ribcage or abdomen, etc. Also, it was important to learn if his fall resulted from tripping, being dizzy, having chest pain, or any other variety of medical concerns. Learning the mechanism of his fall would help me gauge how in-depth to question him and how aggressively to pursue medical testing.

He ignored my question, instead initiating his own direction of conversation. “How long have you been a doctor for?”

Inside, I was smiling at this patient’s piss-and-vinegar. To be eighty-five and have this much energy, regardless of how it would be interpreted by others, was pretty damn cool.

“Well, sir,” I answered, “I finished medical school in 1993. I finished residency in 1997. So I guess that would mean that I have been a doctor for twenty years and have been finished with my residency training for, well (I had to do quick math in my head at this point), about 16 years.”

He nodded his head in approval while turning to his wife to speak. “I guess he will be okay to fix my elbow.”

I turned to find her directing a genuine and loving smile at her husband. Turning back to my patient, I continued with my questioning. “Sir, did you trip over something that made you fall or did you have a dizzy spell?”

“Doctor,” he said, looking me directly in the eyes, “I tripped over an uneven sidewalk. Last time I hurt myself like this, I needed stitches right here,” he continued, pulling up his pant leg to reveal a small scar on his anterior left tibia. “I need some stitches in my elbow and then you can let me go.”

I asked him several more questions, straining my ears to decipher his answers through the heavy veil of his accent. Eventually, with a lot of patience and a little probing, I felt satisfied that his isolated elbow injury was not associated with more serious concerns.

As I began to gently unwrap the gauze-dressing from this patient’s elbow, he began to warm to me, rhythmically raising and lowering his arm to help with my efforts. When I was finally done, I closely examined his elbow. He had a localized contusion with a superficial skin-tear of the overlying skin. This tear would not require stitches, nada one. He had minimal pain on range of motion testing to his elbow and had no further pain to his left arm.

“Well, sir,” I said to him as I sat on the stool by his feet, “I have some good news for you. We will need to get an X-ray to make sure you didn’t fracture your elbow, but otherwise you won’t require any stitches.” I explained to him that we would put steri-strips on his skin tear to approximate the edges and that stitches, as he was insisting, could actually be detrimental to his healing.

“Doctor,” he replied, “I want stitches. Just like last time.” Uh, oh. I felt an argument coming on. So instead of addressing him, I turned to his wife and spoke. “Ma’am,” I said, “has your husband always had this much piss-and-vinegar?” At this question, both the patient and his wife burst out laughing. “Doctor,” she replied, “you have no idea!”

After a little more persuasion, I was finally able to convince this patient that he did not need stitches. He willingly went to x-ray and after returning to his room, I went into his room to tell him the good news — he did not have a fracture. His wife, upon hearing the news, clapped her hands together in happiness. After a few pleasantries, I began to walk out of the room. “The nurse will be in to clean and wrap up your elbow as well as update your tetanus,” I assured him, recognizing that the patient was very eager to get released from the department, “and I should have your discharge instructions ready in ten minutes.”

Within two minutes of leaving his room, not surprisingly, the patient was standing at the nurses’ station counter, barely visible as he strained to peek over. “Excuse me,” he spoke in his drawl of words, “I am ready to go and I haven’t been given my papers and my elbow hasn’t be dressed yet.” I looked up from my computer and smiled at him. “I am working on your instructions right now, sir, and then the nurse will be right in to get you going.” Inside, again, I smiled at this gentleman’s energy.

And then, the moment I almost missed …

“Doctor,” he said, “can I ask you something?” As he spoke, he wife walked up beside him at the counter. She was an identical twin to Sophia on The Golden Girls.

“Of course, sir, ” I said, standing up and walking towards him. “What can I help you with?”

“Well,” he said, “you have a funny accent. Where are you from?” His question caught me off-guard, and with our conversation it seemed that every nurse and secretary sitting in this station also paused. I smiled at him and answered his question, explaining that I am a second-generation American of European-descent with an accent which I associate with being part country-boy (a “hick-accent,” as I like to say) and part European (as one of my heroes, my paternal grandmother, had a very thick accent). And with his bold question, I returned the favor.

“And where, sir, are you from?” I asked. “I noticed that you have an accent yourself.”

“You are quite right, Doctor,” he answered. “I am originally from Poland.” After we joked about our shared love of polka music and vodka, I asked him another question. “How old were you when you came to America?”

And with my question, this patient launched into his past history. He came to the United States at the age of twenty, alone, after WWII. When he was an innocent child of age eleven, he tragically lost his entire family in the throes of war — his parents, his five sisters, his aunts and uncles, and all of his cousins. Each and every one in his family died in concentration camps. He survived only because a farming family took him in as “one of their own” during the war. Afterwards, when he had saved enough money, he came to America to begin a new life.

“And Doctor,” he commented, after finishing his amazingly breath-taking story, “isn’t it remarkable that after all of these years in America, I still have my accent?”

I looked around the station. Not one of us had eyes that weren’t moist and glistening. This man’s incredibly powerful story, portraying his resilience to the most tragic circumstances of loss and adversity, was equally heart-shattering and faith-building. We had all just been handed a rare nugget of vitality. For this man to share a sliver of his soul to us was beyond any measurable gift.

After his story, we all thanked him for sharing. Gradually, he worked his way back to his room. Without his presence at the counter, you would think that we would all have comments on such an incredible story, and yet none of us could utter a single word.

This frail elderly man was anything but frail and elderly. He was one of the strongest, most awe-inspiring patients I have ever had the pleasure to meet. And that remarkable accent of his? Thankfully, I learned from this man that his accent was probably the least remarkable thing about him.

And to think, I almost missed his story …

“StorytellERdoc” is an emergency physician who blogs at his self-titled site, StorytellERdoc.

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  • Anthony D

    WOW….That is powerful! Thank you for sharing this story doctor!

  • Suzi Q 38

    What an interesting story.

  • militarymedical

    That’s a lovely story, and I imagine those of us who have been part of the medical world for more than a few years have similar ones to tell. Having experiences like that is one of the decidedly better rewards of the job.

    That said, I have to ask: rather than push for details of the how/why/when/where related to his injury before even looking at the injury, why did you not do that AS you examined him and his injury? I’m nowhere near my mid-80s, but I much prefer having my doctor(s) paying attention to the reason I’m there immediately. How I got there can be told as the exam progresses.

    You might have put him more at ease had you paid immediate attention to what HE thought was most important … getting the back-story as you went along.

    Just a suggestion …

  • Afdrmom

    As a military family physician, I love to hear the stories of my patients. The older ones have lead incredible lives and seen amazing things

  • Adolfo E. Teran

    nice story, he looks grumpy but he was not , he was just waiting for the moment to connect with you. It took you by surprise.

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