The first-year medical student and the 114-year-old patient

I thought the most important thing I had learned while working in the emergency department as a first-year medical student was to bop and weave.  The impeccable foot skills I harnessed as a youth lacrosse player were put to great use- to stay out of the way.  The quiet whisper of a nurse trying to slide behind me, and — BAM — back against the wall.  I can hear the echo of my two older brothers yelling at me, “Go make yourself useful.”  So I did, by staying out of the way.

Like a goldfish in a sea of minnows, I stuck out.  My polka dot notepad jumping out of my short white coat while simultaneously weighing one side down, and my eager smile were enough to get me eaten.  Not to mention my synagogue-appropriate attire, due to a lack of spare scrubs, did not help much either.  It was mastering the bop and weave that gave me some confidence, allowing me to feel like I could kind-of-maybe-sort-of fit in, by staying out of the way.  I was so adorably clueless the first few times I rotated through the emergency department.  The fourth-year medical students would look at me with the same look of pity and uneasiness as my classmates did when I wet my pants in the first grade.

Jane Doe came in to the emergency department on a rainy Wednesday morning at 8:00 a.m.  She was found wandering around an apartment building that was not her own.  I had yet to see this woman in person, but had heard about the 114-year-old patient without a name.  Resident after resident spoke with Ms. Doe, yet no one could seem to figure out who this woman was.  I was walking towards the linens to fetch a blanket for one of the attendings when I saw the eyes of my resident and the two fourth-year students on my shift following me.  I caught the gaze of the three of them as their sly grins pierced through me.

“Hey.  First year.  Why don’t you take this patient.” The senior resident bellowed to me with a look of amusement as he handed me a clipboard with a patient’s chart.  I looked down at the clipboard.  JANE DOE 114-YEARS-OLD.  “If you can get even one piece of accurate information, I will be impressed.” He said, already bored at even the prospect of my attempt.

Oh. It. Was. On.  I gave him the same look I give strangers who tell me to smile.  “I’ll get two.” And I marched off.  But once I was out of the view of my resident, my confident stride dissipated into an uneasy strut.

I sauntered on up to my comforting, smart, and patient preceptor, the kind of guy who is always the nicest person in the room, no matter where he is.  “Dr. G … is this patient … really … 114-years-old?”  I asked apprehensively, knowing that my question probably made me look like a witless first year.

“Oh, no. We just write that on there instead of saying that we don’t know the patient’s age.”  Dr. G answered, skipping the beat of harsh judgment.  “She’s over there.” He pointed to the curled up elderly woman lying in the hallway and laughing at the ceiling.

“Oh, okay great. Thanks. That’s what I thought.”  I lied, still truly unclear as to whether or not the patient was actually 114-years-old.

Jane Doe was lying in an emergency room bed in the middle of the hallway.  Everyone was bustling past her without even the tiniest glance her way.  I approached her, pulling up an abandoned chair.  Her smile singed my skin with sadness. This woman was wiser and older than all of us, yet humor displaced our appreciation.  Dementia, one of the scariest and most prevalent pathologies had taken hold of her.  A disease in which we lose complete control over our own minds; and here we were, taking even more control away from this woman by placing her in a hallway instead of her own room and putting sticking a bright-eyed and senseless first-year medical student in front of her. on her- polka dot notepad and all.

“Hi ma’am.  My name is Elyse.  I am a first-year medical student.  Would it be OK if I asked you a few questions?”  I asked as she grabbed my hand and pursed her lips into a smile.  She was missing her teeth but she was well dressed and seemingly put together.  “What is your name, ma’am?”  I asked.

“Dorty Cuninam.”   Enunciating each syllable was a full-body chore.

I looked through the paramedics’ notes from her arrival.  The name on the paramedic’s sheet read, DOROTHY CUNNINGHAM, in tiny letters — letters much smaller than the name that appeared on her cover sheet.  The paramedics had gotten her name, but the residents and attendings did not believe that she knew her own name.  She was documented as JANE DOE.

“Can you spell that?”  I asked.

“D-O-R-O-T-H-Y C-U-N-N-I-N-G-H-A-M,” she spat back, clearly confused as to why I would make her spell her own name.  But the speed at which those letters were thrown at me was not a sign of a confused woman.  It was the sign of a woman who had established her identity a long time ago, years before I even had my first breath.

I believed her.  And with that, I crossed off JANE DOE.

“What brings you into the hospital today?”  I asked. Trained like automatons to lead with this inquiry, I knew this was not the most appropriate road of questioning to venture down.  Ms. Cunningham began to speak fast and unintelligibly, moving her body with each syllable as though she was hulling the words right at me.  I continued to try and ask pertinent questions, like where she lived, and where she was when the paramedics arrived?  But none of my questions led to an intelligible answer.  I couldn’t understand her language — and then it dawned on me.

“Where are you from Ms. Cunningham?”

“Here!”  She said as she pointed aggressively to her hospital bed.

I knew I could have phrased my question better.  This woman did not know where she was or why she was here.  I needed to somehow trigger the memories that reside so far back in our own minds that we forget they’re there.  “Where were you born Ms. Cunningham?”  I asked.

“Hungary.”  She gritted through her teeth.

Everything made a little more sense.  Her unintelligible English words were not English words at all. She was mixing Hungarian and English into a dialect no one could decipher.  I was never going to get a chief complaint or history of present illness.  But I knew that if I were patient, I could get some real information — the kind of information that is much harder to forget.

“When were you born, Ms. Cunningham?”  I asked.  Hoping she would be able to ramble of those digits in the same thoughtless manner as she did the spelling of her name.

“26. 26.”

“Were you born in 1926?” I followed up, only to be answered by a blank grin.  “Can you remember the month?”  I asked, hoping that her birthday would be something so ingrained in her, she wouldn’t need to reach too far back into her memory bank.

“626 … 26 … 26!”

I could tell I was not going to have her attention for much longer.

Maybe my resident was right.  Maybe my efforts were bleak.

I scribbled those numbers down on my notebook and desperately tried to think of something that would help us identify her.  I asked her what she was doing this morning, what she had for breakfast, where her husband was, where in DC she lived.  All these questions were met with unintelligible answers.  I could not go back to my resident and tell him that Ms. Cunningham lives in the hospital, that her husband is our boss, and that he is going to fire us all for doing a horrible job.

She did have a point though.

I stared at Ms. Cunningham.  The fluorescent hospital lights illuminated how devastating the reality of this situation really was.  And that is when I noticed her hands.  Her freshly manicured fingernails glistened against the bright lights of the emergency room.  In my own Legally Blonde moment, I realized that she did have loved ones, or at least a caretaker that took her on an outing no more than a week ago.  But no nursing home, assisted living organization, or home aide had reported a missing person.

She must have children.

“What are your childrens’ names?” I asked, skipping the inquiry as to whether or not she had any.

“Tom and Mary.” She echoed back through her toothless grin.  “T-O-M, M-A-R-Y.” She spelled out, unprompted.

There was something different about the way she answered this last question (other than the cheeky spelling).  Her answer came from a mother who knew the names of her own children.  I thanked her for her time and walked over to Dr. G and the emergency room’s social worker.  I rambled off all the information I could about the emergency room’s JANE DOE.

“Her name is Dorothy Cunningham.  She didn’t even hesitate when I asked her to spell it.  And that is not an easy name to spell.  I couldn’t get exactly how old she is, or where she lives, because she thinks she lives in the hospital.  But I did notice that she had a manicure a few days ago.  And that makes me believe that someone is taking care of her.  She told me her kids names are Mary and Tom.  And I believe her.”

“Well.  Thank you for trying.”  My attending said in a sympathetic tone, only to be cut off with the sheer jubilation of the social worker.

“Wait. This is very helpful. Great eye. Tom and Mary you said?”  He fled off to a computer screen and within three minutes he had the cell phone numbers for four different Tom Cunninghams residing in and around the DC area.

Twenty minutes later, Tom Cunningham and his wife ran into the emergency room, embarrassed and grateful.  After speaking with them, my attending came over to talk with me.

“You did a really great job taking the time to listen to her.  You belong here.  Oh — and she is 87, not 114.  I know that was concerning you.” He laughed.

“Did you happen to get her birthday?” I asked.

“Yeah.  June 26, 1926.”

Elyse Linson is a medical student.

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  • DawnKA

    This was great. I cannot stress that enough as I often speak on understanding cultures and the people that you serve – it is so important.

  • maggiebea

    Wow! Brilliant result, and (yet another) awesome demonstration of the importance of actually paying attention to what the patient is saying. I hope when I’m 114 (or even, ‘only’ 87) and disoriented in the hospital, I am lucky enough to have someone listen to me the way you did. And to notice the details that give clues to my life outside the hospital, even if I can’t remember them just then. And I’ll just mention that she’s not the only elder who has been asked their birthday enough times to just say 6 26 26.

  • EmilyAnon

    Your story should dispell any doubts people may have about the value of medical students in the hospital setting – mine included. Well done.

    • querywoman

      Extra bodies often help.

  • guest

    Great story. The only surprising thing is that your attending did not appear to appreciate how important it was that you had figured out her name? When my students obtain that sort of information, it is extremely helpful…

  • winslow57

    Very nicely done. May I add that with elderly, confused or emotionally traumatized patients, a quiet room that is not as “hospitally” as an ER exam room can calm the person and elicitation of information in a conversation over a beverage of the client’s choice can be very helpful. First think of the patient’s comfort, provide that, and you will get your history much more easily and you can avoid re-traumatizing them. Safety, kindness, and respect help you build trust and rapport with confused or fearful patients. Listening is a profund and potent act of kindness; you were kind to her.

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