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Fifty-Seven-Year-Old Female
Change of Shift Fifty-Seven-Year-Old Female
Fifty-Seven-Year-Old Female
David A Peak, MD
[Peak DA: Fifty-seven-year-old female. Ann Emerg Med September 1999;34:406.]
Department of Emergency Medicine Boston Medical Center Boston, MA Address for reprints: David A Peak, MD, Department of Emergency Medicine, Boston Medical Center, 818 Harrison Avenue, Boston, MA 02218. Copyright © 1999 by the American College of Emergency Physicians. 0196-0644/99/$8.00 + 0 47/1/99362
4 0 6
It had been awhile since I had seen her, 57-year-old female; the other times she had been in for COPD. We had talked more often about her quitting the habit as she became too familiar with her community hospital. She recognized me the first day and seemed to understand. Right hemi—but it was not being able to speak that was especially frustrating, since she had always had “the gift of gab.” I said goodnight. She painfully tried to. It didn’t last long. In the morning with some imagination you could make yourself believe she knew you were there. Imagination stretched to faith. We ordered a repeat CT and I spoke to the family about prognosis and heroic measures—yesterday’s talk of prolonged rehabilitation a distant memory. We discussed the lack of evidence that any therapy might change the outcome, but they preferred to give it a try, said she deserved it. We made a plan together. In the evening, I made arrangements for the ICU transfer. The resident was not impressed by the blown pupil, the posturing, and told me the plan was a waste of time and wouldn’t matter. The intern and I transported her to the unit. I stood at the foot of the bed. My suggestions for more sedatives and lidocaine had been sharply refused. The resident’s tube went in on the fifth or sixth try during an eternity. The following day on a sunny afternoon, it hadn’t seemed like a waste of time to the family, who all got to say their goodbyes, or to the three organ recipients (one liver, two kidneys). We buried my mother that weekend. I returned to my big-city hospital, reminded that the little things almost always matter to someone.
ANNALS OF EMERGENCY MEDICINE
34:3
SEPTEMBER 1999
Fifty-Seven-Year-Old Female
David A Peak, MD
[Peak DA: Fifty-seven-year-old female. Ann Emerg Med September 1999;34:406.]
Department of Emergency Medicine Boston Medical Center Boston, MA Address for reprints: David A Peak, MD, Department of Emergency Medicine, Boston Medical Center, 818 Harrison Avenue, Boston, MA 02218. Copyright © 1999 by the American College of Emergency Physicians. 0196-0644/99/$8.00 + 0 47/1/99362
4 0 6
It had been awhile since I had seen her, 57-year-old female; the other times she had been in for COPD. We had talked more often about her quitting the habit as she became too familiar with her community hospital. She recognized me the first day and seemed to understand. Right hemi—but it was not being able to speak that was especially frustrating, since she had always had “the gift of gab.” I said goodnight. She painfully tried to. It didn’t last long. In the morning with some imagination you could make yourself believe she knew you were there. Imagination stretched to faith. We ordered a repeat CT and I spoke to the family about prognosis and heroic measures—yesterday’s talk of prolonged rehabilitation a distant memory. We discussed the lack of evidence that any therapy might change the outcome, but they preferred to give it a try, said she deserved it. We made a plan together. In the evening, I made arrangements for the ICU transfer. The resident was not impressed by the blown pupil, the posturing, and told me the plan was a waste of time and wouldn’t matter. The intern and I transported her to the unit. I stood at the foot of the bed. My suggestions for more sedatives and lidocaine had been sharply refused. The resident’s tube went in on the fifth or sixth try during an eternity. The following day on a sunny afternoon, it hadn’t seemed like a waste of time to the family, who all got to say their goodbyes, or to the three organ recipients (one liver, two kidneys). We buried my mother that weekend. I returned to my big-city hospital, reminded that the little things almost always matter to someone.
ANNALS OF EMERGENCY MEDICINE
34:3
SEPTEMBER 1999