I occasionally read other medical blogs, and the posts I usually enjoy are the ones with a gripping story. I've told a few myself. But there haven't been many in my own field. Unless I'm dropping lines or coding people in the ICU, my job is a lot of talking to people and writing long notes. It isn't all that surprising to me that I'm interested in the more procedurally oriented subspecialties.
All of which made it easy to overlook Mr. Arthur. He suffers from Parkinson's disease and dementia, so when I read that on the chart in the ER and then heard him say "I've never had a tremor before" I discounted his story, chalking him up as another demented patient with poor historical skills. I had gotten called on two patients at once, so I left Mr. Arthur to tremble in his bed a little longer while I got the much more exciting acute pancreatitis patient upstairs.
Coming back to Mr. A, I got his story a little clearer. He was worried. Worried that his home blood pressure cuff was giving widely variable readings, worried that the ER doc told him his heart was in trouble because of "a tremor in the way it beats" (the ER resident meant atrial fibrillation) and worried because his baseline tremor was getting bit worse. I was able to fix one concern right away, (and this illustrates my irritation with the ER residents) by just looking at his EKG. There was certainly an EKG showing atrial fibrillation in Mr. Arthur's chart, but the problem was it said "Betsy Rosengard" across the top. Mr. Arthur's EKG was not completely normal, but it certainly hadn't changed from the last time he had been admitted, a year previously. The tremor I wasn't sure about, but his blood pressure concerns, especially in a 90 year old man, were enough to warrant at least a 23 hour observation period. I got him upstairs and promptly was swamped by the other 30 or so patients requiring my attention.
Later that night, I was going through Mr. Arthur's clinic notes in a bit of downtime, and I noticed that his primary neurologist mentioned he was a writer. I checked his name on Amazon and found that my patient had written 11 books, several on the Korean war, in which he fought, and a few on other American conflicts. So when I swung by his room on my evening rounds, I asked him about it. He brightened up immediately, and began telling me his life story. Though his mind wanders at times, he is still quite sharp, and he told me about joining the Canadian Army in 1940 because he was desperate to "kill them Nazi bastards." While there he met King George VI. He transferred to the American Army after Pearl Harbor and was made a tailgunner in B-26s. He didn't want to fly and so transferred to the infantry, where he went to Germany after the surrender to guard POW camps. He still remembers the names of the SS officers he was charged with keeping under lock and key. After WWII he came home and married, staying in the Army and going to Korea, where a lot of the experiences in his books come from, apparently.
I was amazed I had ever seen this fascinating man as just another patient. I realized that I just hadn't given him a chance to tell his story, and that all of his concerns were valid, he just didn't talk fast enough to convince me in the 30 seconds I had given him.
I didn't want to leave, but I had to let the man rest, and I had other patients to see, but I came back to his room the next day and chatted for over an hour after I had signed out, and could have been at home, asleep.
I may regret not sleeping that extra hour this afternoon, someday, but I doubt it.