Her wary eyes, magnified from her thick-lensed spectacles, watched my every move as I pulled Room 21's curtain to the side and entered her room. In her early eighties, it was apparent to me that my entrance into her life was more important than the abdominal pain that brought her to our Emergency Department. In the corner sat a slight man with wispy gray hair poking out from the border of his baseball cap, his elbows resting on his thighs as he leaned forward in his chair. His wrinkled face and tired appearance made me question if this man was her son or husband.
I returned my gaze to this patient and gave her a smile as I approached her bedside. Her stoic face softened slightly as I watched the corners of her eyes relax. Her mouth's edges lifted slightly into a hesitant return smile. She was on guard.
Arriving to the side of her cot, I extended my hand to introduce myself. "Hello, Ms. Westin. My name is Dr. Jim and I will be taking care of you today while you are in our Emergency Department."
"Hello, Doctor," she replied, barely grasping my hand in welcome. "Please call me Bertha."
"Nice to meet you, Bertha," I answered before turning to the gentleman in the corner of the room and approaching him. Once again, I introduced myself.
"Thank you, Doctor. My name is Sam. I'm her son."
Her son. Standing closer to him, I could see that Sam had his mother's eyes--slightly hazel but more fatigued-appearing. My mind wanted to know what in his life was giving him this look of defeat.
"Nice to meet you, Sam. Thank you for being here with your mother today."
Sam nodded to my words. My response words--actively thanking him for taking the time to accompany his elderly mother to the Emergency Department--were something I had been saying for the past few years to adult children who accompanied their elder parent to our department. It was my way of acknowledging and validating their efforts in helping their ill parent in a time of need. Of putting to the side their own needs and demands. Of dropping everything at that very moment to be at their parent's side during an Emergency Room visit. This supportive action was one that I respected immensely. Often, it was the adult child who could convey just a little more history or provide just a bit more support that could make a difference in my course of treatment of their parent.
It was a loving gesture that was not lost on me.
I turned back to Ms. Bertha and began questioning her. She had developed abdominal pain in her midepigastric to left upper quadrant about four hours prior to her arrival. It was not accompanied by any nausea, vomit, diarrhea or constipation. She had no fever. She denied any chest pain, shortness of breath, or recent trauma. She denied any urinary complaints. This abdominal pain was unusual for her. It had presented soon after she had eaten a BLT sandwich for lunch. Of course, like Murphy's Laws would dictate, the pain had completely dissipated by the time I examined her.
As I questioned her, I could see her slowly letting her guard down with me. She began to smile her big, beautiful smile more easily. She became more conversive. She became down-right fun. We laughed together at some of our small talk while I finished my history-taking and began my physical exam.
Her physical exam was perfect. Nontoxic. Benign. I couldn't find a thing wrong with her.
Because of her age, we did the standard precautionary testing, including blood work, an EKG, and a urinalysis. While waiting for her test results to return, I stopped in several more times to perform recheck exams and make sure she remained comfortable. She did. Each time I stopped in, I became more and more aware of her piss-and-vinegar disposition and sense of humor. Especially talking about Bingo, she seemed to light up at the sense of fulfillment this church-going sport brought her. "Yeah," Sam added, "don't try to get between Mom and her Bingo chips." Ms. Bertha, it seemed, did not take lightly to losing a recent big prize by one empty block on her card.
Finally, I went in for the final time with all of her returned test results. All results were normal and favorable.
In the few hours I spent with her, I continued to appreciate Ms. Bertha and her son, Sam. I was happy for both her feeling better and her excellent test results. I was happier at the sense of caring that existed between mother and son. I was happiest that, at age 83, Bertha seemed to continue to enjoy life and found beauty in the simple things that it offered. I was also appreciative that losing a Bingo game still evoked passion from her.
On review of her previous visits, I had noticed that she had never been to our ER before. I questioned her on this prior to discharge.
"Ms. Bertha," I said, "I noticed you haven't been here before. What made you nervous enough to come in for your abdominal pain today?" I wanted to make sure I had covered all of my bases before safely discharging her to home.
"Oh, that was probably my doing," Sam answered. "After the past few years," Sam continued, "I didn't want to take any chances with Mom's health with her belly pain today."
"Plus," Ms. Bertha added, "I really hated my doctor the last time I had to go to the ER. That was in 1975." She paused slightly before continuing with a wink of her eye. "Don't worry, though, Dr. Jim. I really like you."
I must have blushed at her kindness because she called me out on my "red cheeks."
"Can I ask what has happened in the past few years to you, Ms. Bertha, that had made your son worry about you today?"
And then, Ms. Bertha's real story came rolling from her mouth, her words tumbling right into the pit of my heart.
With a mixture of sadness and smiles, Ms. Bertha and Sam, in the next five minutes, told me how Ms. Bertha's life had played out to this point. She had lost four children--two sons (one to cancer and one to AML with a concurrent brain tumor) and two daughters (one tragically in the late 1980s from a motorcycle accident). Her husband had died five years earlier. In the past year, she had buried two siblings. This recent loss of her siblings had convinced Sam that his mother's abdominal pain was going to bring terrible results. Sam was her only immediate family left.
When they were done sharing, I could only shake my head in disbelief. I grabbed Ms. Bertha's right hand between my two and warmly rubbed it. "Ms. Bertha," I said, "I can't even imagine how you could share your smile and piss-and-vinegar attitude (saying piss-and-vinegar made her giggle like a young school girl) with the world after all that has happened to you. What keeps you going?"
She looked me in the eyes, her magnified hazels piercing my soul.
"Bingo," she answered.
We all laughed. Her resilience and true personality made me smile. My goodbyes to Ms. Bertha and Sam were heartfelt.
As I stepped from Room 21, I was hopeful that, thanks to Ms. Bertha's inspiration, I too would find my "Bingo" someday.
I will keep looking...
As always, big thanks for reading. Ms. Bertha and her son were an inspiration to me. I am constantly amazed at the gift I have been given to meet so many diverse and beautiful people.
What's your "Bingo?"