Unforgettable
Both threats resolved with tears and empathy as I met with them and acknowledged the error; after full explanations, they agreed with the final decision.
Put Bar Codes on Families, Too!
A mildly demented older man was admitted for something small. In comes another man and says, “This is my brother, and he’s ready to go.”
“Really?” I asked. “That’s your brother?”
“Yes,” he answered. “That’s my brother Jim.”
“OK, great,” I replied. And Jim takes him home.
Two hours later, the family shows up and tells me he doesn’t have a brother. It turns out that at the church the patient attends, they call each other “brother.’”
When They Know, They Know
I got called to see a patient. “What is the matter?” I asked him.
“I’m dying,” he said.
“What do you mean?” I asked. “Do you have chest pain?”
“No,” he replied.
“Are you short of breath?” I asked.
“No,” he said.
“Are you feeling a fever?” I asked.
“No! I’m dying!” he exclaimed.
I found nothing from the interview. I did a physical exam and found nothing. I called other physicians in who were seeing the patient. Everyone said, “I don’t know what he means.” The patient died within the hour.
I’ve had this happen to me four times. In three of those cases, they said, “I’m going to die today.”
In the other case, the patient said, “I don’t feel right.” When I asked him what he meant, he said, “I don’t know. I just feel weird.” And then he died that day.
Ask the Patient Why
I have a number of patients with sickle cell disease who have chronic pain syndrome. I had a female patient—about 26 years old—who basically stayed immobile for two weeks. The staff was upset with her about that.
To each other, they referred to her as noncompliant, and we wondered, “Why won’t she get up? She won’t even try to get out of bed.”
When I was assigned her case, I said to her, “Everyone says you won’t get out of bed. Will you tell me why?”
“You’re the first person to ask me that,” she said.
“Well, then,” I asked, “why?”
“I have an artificial hip,” she said, “and it is dislocated.”
When the physicians and other staff had urged her to get up, she had simply said, “My hip hurts.” It turns out that she was clinically depressed and was angry because she felt frustrated that she was always being judged.
Ultimately, she died two years later from the same problem in another hospital where she had developed DVT. In that other hospital, she’d done the same thing: She had refused to move, and the staff had told her she had to move—but no one had asked her why she hadn’t. TH
Andrea Sattinger writes frequently for The Hospitalist.
