Friday, May 21, 2010

The Lonely Walker

They made a regal couple, the elderly man and woman sitting in Room 19. She was the patient, he the supportive husband. She sat in the treatment cot while he sat in a chair pulled near her bedside. Together, they greeted me with their warm smiles as I walked into their room.

They both had full heads of healthy, silvery hair that shimmered from the overhead fluorescent bulbs. Their eyes were intense and watchful, and their crescent lips, framing big, teethy welcoming smiles, stretched like thick, pink rubberbands across their lower faces. He was impeccably dressed in conservative, mid-season wear, including a green layering-sweater. She was in a threadbare hospital gown, clearly confident and stylish despite her outfit.

After introductions and the shake of our hands, I learned that they were both in their early eighties and had been married all of sixty years. Sixty years! Can you believe that? How amazing. I congratulated both of them on achieving such a milestone.

"I know where I'm going," she laughed, looking heavenward, "for putting up with him all of these years." He laughed harder at her words than she did.

This, ultimately, explained the matching walkers that were parked against the counter in Room 19. Who needed matching rings for a 60th anniversary present, anyway? I would think that I, too, would be more practical on my 60th anniversary. I noticed these walkers immediately upon entering the room. His and hers. Identical. Front wheels, back posts with thick rubber stoppers, and a right-sided hand brake on each. Greenish-blue in color. Her's had feminine clothing casually strewn over the front bar.

She was 82, to be exact. "He's a few years older than me," she jokingly added, dismissively nodding toward her husband, "I'll always be his spring chicken." By triage notes, she had presented with a two-week history of worsening abdominal pain "that came in waves," mainly to the right upper quadrant. "But right now," she told me, "it isn't so bad." It seemed to be associated with any intake of food.

She still had her gallbladder and my first three thoughts of the cause of her pain were gallbladder, gallbladder, and gallbladder. Of course, elderly women thoroughly enjoy stumping us in the medical field, so I also entertained other suspected reasons for her pain--an ileus (where the bowels are less efficient in moving air or material forward), a bowel obstruction (where the bowels kink on themselves and prevent any forward passage), referred pain from the heart or lungs, an atypical urine infection, or some form of peptic ulcer disease.

I questioned her further. She had no fever. No change in bowel movements. Some occasional nausea and bloating. Then, I asked her one last question, whose answer raised my suspicions beyond the normal concerns.

"Do you have a cancer history, Mrs. Brown?"

"Actually," she answered reflectively, "I do. I had breast cancer about a year ago." She looked over at her husband and smiled. "Remember those days, dear?" She explained that she had undergone chemotherapy following a right mastectomy.

Oh no, I thought to myself. Add metastatic cancer to that list. Unfortunately, I have seen several cases of elderly patients with a remote history of cancer who had presented with a recurrence of their cancer, abdominal pain being their only complaint. I could only hope Mrs. Brown wouldn't be in that category.

I did my exam on Mrs. Brown. Sure enough, she had significant abdominal pain to her right upper quadrant, but only if I was palpating deep in that area.

I explained my suspicions to her. We would need to test her urine, her blood, perform a chest x-ray, and finally, the most important of all the tests, perform a CT scan of her abdomen. That would effectively rule-out or rule-in my biggest concerns. Because we had just had a stroke patient and a trauma patient before her, I explained her workup may take a few hours time.

"Honey," she said to her husband, "go ahead out to the car and take a nap. I'll be all right in here. Dr. Jim," she added, winking at me, "will take good care of me."

Any other night, I would have worked hard to find an extra cot for Mr. Brown, but this night in the ER was crazy. I knew there were no available beds. "Go on, Mr. Brown," I said, "you have a few hours nap time ahead of you. I'll take good care of your wife."

I left the room and let Mr. and Mrs. Brown have a private moment. Minutes later, I saw Mr. Brown shuffling down our hallway toward the exit sign, guiding his lonely walker along the way.

Slowly, Mrs. Brown's results started to return. Her urine was clean. Her chest x-ray was unremarkable. Her blood work, however, returned with two concerns-a mild drop in her red blood cell and platelet counts and an elevation in three of her liver enzymes.

I entered her room to explain her results to her. And also to share that she was now second in line to go over for her CT scan. She was, however, napping. I softly strolled up to her lone walker to check it out more closely. It was spiffy. I've only seen aluminum and black walkers before, and was wondering if this was a custom paint job.

"I never wanted that thing," Mrs. Brown said, my back to her, startling me. I turned around. She had awakened. "Edgar needed one. I was afraid he was going to fall. But you know men...he insisted that he didn't need one. The only way I got him to finally accept using one was if I got one, too."

I nodded. "They sure look nice," I said. "Thank you," she said, "they are identical. We call them "the twins." If I had to use a walker I didn't really need, then at least I was going to pick out a color that suited me."

I smiled before remembering the business at hand. Slowly, I explained to Mrs. Brown what I had meant to explain when I first revisited her room. After finishing, I assured her that I would be back the minute her CT results returned.

An hour later, I walked, heavy-hearted, back into Mrs. Brown's room, accompanied by her nurse. Mr. Brown had returned, his silvery hair now somewhat mussed up from his successful nap. The greenish-blue walkers, side by side again, seemed to present a fortified protective wall. I held her CT report in my hand.

"Good news or bad news?" she asked, as Mr. Brown leaned forward from his seat and grabbed her hand. I looked them both in their eyes.

"Not good," I said. I went on to explain that Mrs. Brown's liver, via CT, appeared abnormal. Not only did she have multiple liver lesions suspicious for metastatic disease, but she also had a solid liver mass that was partially obstructing her small bowels. As I spoke, I appreciated the tightening grip Mr. Brown's hand took to Mrs. Brown's.

We all took a deep exhalation when I finished my explanation. "Well," Mrs. Brown said, "I guess that how she goes, then." She looked over at the two walkers, side-by-side. "I guess I won't be needing that thing much longer, Edgar." Her eyes grew glassy, and I was surprised that she had focused her attention, after such devastating news, on the walker. After spending a few more minutes with them, I stepped out to arrange for Mrs. Brown's admission.

Rare or not, I still strongly believe in the power of prayer, sometimes if even to make me feel a little better about things. I'll admit, though, that there are times when my prayers take on a very different, even bizarre, angle. The night I treated Mrs. Brown, I'm sure, my prayers were along that path. Although, to me, they were quite simple and clear.

I prayed that those walkers would sit side-by-side for another 60 years.

As always, big thanks for reading. To the amazing commenters from my Wednesday post, thank you, thank you. Too kind. Next post will be Monday, May 24. See you then...


The Hopeful Elephant said...

I want those walkers together too!

I think we get sent patients like that to remind us to be humble servants.

Happy weekend, friend!

Empress Bee (of the high sea) said...

oh that one made me cry doc... sarge is having his upper left lung lobe removed on wednesday, it is lung cancer but small. it was found to check for non-hodgkins lymphoma after treatment so i guess that's lucky. i guess. yeah, i guess...

smiles, bee

Amber, said...

I have to admit, I teared up on this one. 60 years, wow..yesterday I celebrated my 3 year wedding anniversary, I only hope we have 50+ years ahead of us. Good job, doc.

Anonymous said...

Please tell us the rest of the story, if you know it. This really touched me. And made me realize that as we age, we come to grips with illness and dying. Thank you for reaching me with your stories.

Kate said...

I like the ones where it's just a gallbladder better. Sigh.

rlbates said...

It isn't true that "only the good die young." Wish these two had many more good years together.

tracy said...

"The Twins"...yes, this one made me want to cry too. What a lovely couple. And the most wonderful doctor to deliver such awful news.
Thank you, again, for a very touching story, Dr. Jim. Prayers to you.

kate sweeten said...

That one made me tear up, for sure...I work in an outpatient clinic at a busy hospital. We deal with a large number of elderly patients. There was one couple in particular who always made my day when they came in - dressed up from head to toe, married forever, always holding hangs...they were always so pleasant to deal with. I got the unfortunate news the other day that the wife passed away last week and I find myself at the edge of tears every time I think about it. That poor husband...that lovely woman.

Gia's Spot said...

Oh Dr Jim
What a wonderful story! To be one half of that whole must have been beautiful, the woman sounded so strong and so content that fate had stepped in and there was nothing she could do to change it! I picture her getting everything ready for her husband to be without her, worry for him and not herself! Thank you once again for putting things in perspective!
Happy weekend to you!


911RN said...

Those walkers were a symbol of their aging, eternal love for one another... as much as any two new, shiny, wedding bands could be! Great post.

The twins- what a hoot.

Thanks for another great read!

Maha said...

My prayers are with the couple and their walkers as well.. so sad.

CharityVL said...

I just started reading you. Having 2 daughters with health issues, I find medical writings very interesting. This post totally drew me in, in every facet possible. I can picture that couple in the ER and was so moved by your story. Thanks for telling it; I'll be back to read more!

Katie Axelson said...

Congratulations, Jim, you made me speechless again. Another great and powerful post.

I also admire Mrs. Brown's strength and, of course, your willingness pray (and admit it). :-)

<>< Katie

Cal said...

Such a sad tale, I don't know how you are able to deliver the bad news... I would just run away.
Good job!

Lisa said...

This made me cry too. It also made me make an appointment with my oncologist. Hopefully he will tell me that it's my gallblatter and to see a gastroenterologist.

Karen said...

This is a very touching story and well told. My folks were campground hosts after they retired. On their 50th anniversary I called to wish them a happy day and asked what they did to celebrate. My Dad said "Oh, we cleaned the toilets and swept out the fire pits." LOL They went on to celebrate 56 years of marriage before my Mom passed in 2001. I think a pair of walkers is a great 60th anniversary gift to each other!

coulrophobic agnostic said...

Sigh. As soon as you mentioned her symptoms I was like, "Oh, she's screwed." No one lives forever, but sometimes even when someone's 82 that's hard to accept.

T4 said...

I already feared the worst when you didn't immediately mention malignancy as a part of your DD. You're a talented writer, no doubt about that.

Anonymous said...

As someone who is married to a man who says to be living another 30 years I was at my tears while reading this. We have 15 years between us, met and married a year later, got a child the following year. I love him and feel like having known him for a long time, but he scares me when he says he'll probably die before turning 80. He was a strong smoker all his life but stopped when our child was born. Being left behind is probably my biggest fear, as I can't imagine living without him.

Thank you for sharing your compassionate stories. Often I felt like leaving the medical field due to so many doctors being not-at-all-empathic morons.

J-Quell'n said...

I have tears in my eyes....a beautiful, yet bittersweet story. I hope one day I'll have someone to share matching walkers with.

Sandra said...

This made me cry, too. I wonder about the husband. Will he survive long without his wife? With other couples I have known who shared that bond, they usually ended up dying within a month of each other.

My husband is 18 years older than I am and we have no children. I dread being left without him someday.

belladawn said...

I am teary eyed! I have no hope for 60 years. I do have hope for what's to come though! I will live life to the fullest with the years I will have with my Love.

Thanks Doc!!!

Anonymous said...

I thought of Cholecystitis, or Acute Pancreatitis until you wrote about the scan results.

How can people live with Cholecystitis anyways.. it's like a time bomb with pain. Totally sucks. Must be very uncomfortable.

On another note, my research notes that group leisure activities supports living a longer life and preventing disease. Interesting that even though they are a couple, she had the subconscious instinct to support him to also help herself.