,
17 tweets,
4 min read
Read on Twitter
[1/17] A story. The talk about death yesterday reminded me of my patient from years ago. Mary (not her real name) was 95, in great health, active in the community and all mental faculties at full strength. She fell and had a hip fracture for which I had to do a hemiarthroplasty.
[2/17] Depending on the study, hip fracture mortality rates are 20-40% at 1 year, usually from heart issues. That’s why we call it a “sentinel event,” and the death generally has nothing to do with the surgery; hip fracture is an indicator of frailty. But I thought, not Mary.
[3/17] She busted up into the clinic 2 weeks from her surgery (when most people have a hard time getting out of bed)... wearing heels. And no cane. Just waltzed in, telling everyone how great I was and how I had replaced her hip. Some people really do have a magical constitution.
[4/17] At 6 weeks, she was back to gardening, bridge club, and dancing. I couldn’t be happier; the odds looked like they were in her favor (though generally, the outcomes for hip replacement in the setting of hip fractures are much worse than for elective replacements).
[5/17] She didn’t show up for her 3 month appointment, and I thought that maybe she was doing so well she canceled. But the office ladies told me she’d been admitted to the hospital. So on my lunch break from clinic, I wandered over to the inpatient ward to see what was going on.
[6/17] I wasn’t prepared for what I saw in the hospital room. She had a sudden stroke that had left her blind. Amazingly, it had not affected her mind, arms or legs, but she was now blind and incontinent. I sat at her bed and let her know who I was. She lit up. “Doctor!”
[7/17] She was more thin than I remembered. She asked me to sit with her for a bit. She told me stories, about her life growing up, her kids, her husband who had passed, and how they traveled a lot. She described where they’d been and how she was sad she couldn’t see it anymore.
[8/17] As she spoke, I noticed she seemed more sad. She loved to paint; blindness had taken that away. She prided herself on being independent her whole life, and now she needed help to go to the bathroom. She said she hated “what I’ve become.” She didn’t want to go to rehab.
[9/17] I told her feelings of sadness and depression were normal after such trauma but that it would get better. She said, “I just really want to be with my husband. I’ve lived a good life, I need to go.” She asked me about the blanket volunteers had knitted for her. It was pink.
[10/17] She was clutching the blanket. “Do you think it’s okay if I take it with me to rehab?” She really wanted some semblance of comfort in this sterile, clinical environment. I remembered the experiment with baby monkeys clinging to soft toys because it reminded them of mom.
[11/17] “Yes, it’s okay to take your blanket,” I said. She reached with a bony hand for mine. If anyone had looked in (and no one did), they would have seen me sitting at bedside of this frail blind woman, tears streaming down my face, but my voice calm, so she couldn’t tell.
[12/17] Once I was certain I wouldn’t give myself away and my voice would stay even, I said, “You will see, it will get better.” She said, “No, I’m going to go soon.” I said, trying to sound peppy, “Now, don’t talk like that, I need to see you in my office for your appointment.”
[13/17] As I was leaving to return to my clinic, I called back, “I’ll see you in two weeks, okay?” And I heard, “No, you won’t.” Something about the certainty in that voice. But I had to shake it off, put eyedrops in so my staff wouldn’t see I’d been crying, and go back to work.
[14/17] Two weeks came and Mary didn’t show. I had the office call the rehab. She had died, peacefully in her sleep, three days after I had visited her. I was sad… But I was also glad that she didn’t suffer anymore. I could tell that her independence was everything to her.
[15/17] Modern medicine keeps many people alive for a very long time. Who decides when to let go? This is why I’m a surgeon. I’m not made to deal with this. I’ll stick to my bones and leave the crying to someone who can handle it. I cannot. I am even uncomfortable with hugs.
[16/17] Mary’s obituary hangs in my office. It talks about her life, gardening, painting, all she’d accomplished in 95 years of life. I don’t know why I have it there, but I think about her sometimes. We could only hope for a life as full, and to go as quickly when it’s our time.
[17/17] My office gets nastygrams from patients who call me “literally the worst doctor on earth” when I don’t give them narcotics for minor injuries. It hurts. It’s mean. But I think about Mary, how she lived and died. I can take being called awful names all day. Because of her.
