Last week at the hospital…

Someone died who wasn’t supposed to die.  Let me explain…We have patients in the hospital in various situations.  Some come in with a straightforward problem; we diagnose it, treat it, and they go home.  Others come in after a long duration of illness, and our job is to prepare that individual and their family for what comes next, and sometimes that is death.   And sometimes, that ends up being precisely what they need.   

This situation was not so straightforward.  This individual had a complicated medical history.  Her prognosis was not excellent, but she had been thriving before coming to the hospital.  This wasn’t a hospital visit that was meant to sort out the dying process; it was meant to improve her health status and send he

Last week at the hospital….. 

I had had it.  Too many days in a row working, too many complaining people, too many demanding patients and demanding families.  Gosh that sounds negative on my part but I’m not going to sugarcoat it, the energy required by healthcare providers is monumental.  You need physical energy to move around the hospital, up and down floors, in and out of rooms, lifting people, catching people, bending awkwardly, reaching awkwardly.  You need mental energy to focus on what you’re doing, to critically think about what is going on with a patient, to determine the best way to treat it, to monitor to see if the treatment you chose was the right one, was it working?  It requires emotional energy (the hardest one of all for me, because I just give and g

I had an older patient with severe dementia who had recently fallen. Unfortunately, as is usually the case, the fall was complicated by a whole slew of things.  She ended up with several fractures, one of which she had surgically corrected.  The post-surgical period was tough on her, she was sent to a short-term rehab facility where she did not do well.  She stopped eating, was barely moving, minimally engaged with others and then to top it all off, she was constipated.  As often happens with individuals affected by dementia, injury or illness can negatively impact their cognition.  Her cognitive decline worsened - her dementia dial turned way up.  Any semblance of herself had almost entirely disappeared.  I took over her care during her seco

This week at the hospital… 

I had a patient (in his 70s) who came in with lower extremity swelling, pain, and redness.  He had scraped his shin on a piece of furniture and it had become inflamed and painful.  He came to the hospital after being placed on antibiotics for the injury but it just kept getting worse.  He eventually developed a massive hematoma (collection of blood under the skin) which resulted in pressure in the leg from swelling, compromising his already irritated (and fragile) skin.  The hematoma eventually burst, requiring surgical consultation.  A complicated hospital course, right? I sat and spoke with this patient for a long time about how the injury occurred and about his medical history, which was lengthy.  He was not clear on how ea

This week at the hospital…

I had a young patient (in his early 60s), that was admitted for dehydration but was struggling with advanced Parkinson’s disease.  He didn’t fit the typical mold of late stage Parkinson’s; he seemed too young for this level of disease, yet here he was.  He also had dementia, an unfortunate complication of Parkinson’s.  His wife was so lovely, so let’s call her Lovely Wife. Lovely wife was a goddamn warrior; advocating for her husband, asking questions, ensuring that his wishes were followed, being present.  It was obvious that these two had had many difficult conversations (when he was still cognitively intact) to get to this place, where she felt completely comfortable executing his wishes.  The recommendation from the medical

This week at the hospital…

I encountered two difficult cases: one, a young person with a frightening set of symptoms and an unknown diagnosis; and the second, an older person with a known (and also frightening) diagnosis that would result in their imminent death (and soon).  In both scenarios, we discussed advanced care directives, sometimes referred to as “patient wishes”.  It may seem premature to discuss the topic of death in your 30s and 40s, but, in my experience, it doesn’t matter what age you are, unforeseen circumstances arise all the time.  For our older subset, it’s important to communicate with your children/family/friends what your desires are.  It is a topic that many people find uncomfortable discussing.  Many are unsure exactly what