Wednesday, April 23, 2014

Bingo Resilience

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?"



D2d said...

My kids and my motorcycle are my bingo. Wonderful post as always. Thank you : )

Debbra said...

The folks in your story went to the ER out of fear for Bertha's well-being. More than once we have had to do that and were called on it in a very confrontational and negative way by the ER nurse or doctor. We always told them that we might not be dying, but we AFRAID. That always made things very quiet in the ER. You are not afraid to understand that fear can be a real problem for families well acquainted with illness and death. Thank you for being a complete person and not just a "doctor."

Holly said...

Your posts are always a bright spot in my day. Thank you for writing.

Julia Robertson said...

Thank you for being one of the Doctors that care and understand. Since brain surgery to remove a tumour, any time I have a brain issue from confusion to headache, I get a ride in the ambulance to the ER. It makes things much less scary to have a Doctor who understands that it can be frightening. I sent a thank you note and balloon bouquet to the Doctor and Nursing team I had on my last visit. Those extra few minutes and actually interacting with the patient as a person makes all the difference.

Lynda Halliger Otvos (Lynda M O) said...

"What's your Bingo?"

Allow me to first say what a pleasure it is to see you come up in my queue. You are one of my all-time favorite bloggers and this post reinforces why !~! Keep on being you-the inimitable you.

The small babies and toddlers that I bring into my home and help raise while their parents work to put food on the table and gas in the car, they are my Bingo. I charge a pittance, care for them one at a time and love them with all my being. My devotion to them extends to the entire family and their pets too. I cannot be or do it any other way. The relationships I build with my Families keeps me getting up every day and sleeping well at night (never mind the hip pain!!)

Thanks for asking. I hadn't thought of it in quite this way before and I like it.

SeaSpray said...

I totally enjoyed your post! As always when you write ...I feel like I am with you in the room. I think it's great that you think the family that accompanies your patients. And you are so observant which no doubt contributes to your eloquent writing.

I can appreciate what it is like to lose so many people and she/they ...certainly had too much loss in their lives. We just don't can't know all the burdens people carry and it's nice that you take the time to care.

I too appreciate her spirit.

My aunt always used to say the cat was full of piss-and-vinegar. Funny expression. :)

Maybe I should try bingo. :)

My family! Especially the grandchildren because children have a way of bringing such joy to everything.

Blogging was my go-to place for myself when I was having health challenges now resolved. I want to get back to it more routinely.

Faith faith in God and all that brings to our lives.

I don't think I have one bingo.

I actually wrote something much longer and will maybe add it - I'll see. What a thought provoking question.

I'll be thinking about this now.

I'm so glad to see you blogging again. Welcome back! :)

Caitlin said...

I'm glad you're back, I've missed your writing :)

310 Hats said...

I believe True Love may be your Bingo. You seem to be one of the people who truly groks that LOVE is a verb of service long beyond its meaning as a mere pleasurable emotion. Keep on loving, doc. You touch and change lives.

JeffW said...

I found your ERdoc posts recently while searching for something else. I can picture you conversing with these patients with that big smile that you always carry. I'm so glad I found your blog because you have a gift in the way you write and touch people's lives. You're a true Chicken Soup for the Soul just as the Dr. ordered.
Jeff W

kmu said...

kindly update your blog more frequently. Waiting for new blogs