Tribal issues

She is 70 and her Rheumatoid Arthritis is severe. Her hands are text book swan necks and her feet are contracted and curved into useless appendages. She is sick with reoccurring pneumonia which is why she is visiting with me on the geriatic service.  She is on multiple anti-depressants which we keep increasing because she is so down.

While we push drugs like they are candy, I took a chance and lost mysel in a hour conversation with this remarkable lady. Her language is that of a person who is grieving. Before this she gestures to her hands, she baked cakes, she planted flowers and she watched her grandchildren. For the last year she has been a Skilled Nursing Facility or SNIF (translation nursing home (translation something not so different than a white collar crime prison)). Even though she has a loving devoted husband and daughter she is in a nursing home. She can’t go to the bathroom on her own and her husband can’t lift her. Our PT on the floor says there is nothing to be done, she didn’t even go see her. I know she is overworked and its about resources but I was still a little sad.

But I was more than sad today, I was down right furious, I asked my patient if anyone had ever mentioned a motorized chair (translation-Power CHAIR-the liberation of the  institutionalized masses). Not her doctor, not her physical thearpist, not a nurse, not a social worker, no one.  People,  this is not rocket science, this is not even the 15 causes of elevated anion gap metabolic acidosis, this is common sense, I could teach a 6 yo old how to solve this equation. A lady with an active life with a terrible relentless progressive disease is not so active because she can’t walk. GET THE LADY A WHEELCHAIR….well her hands don’t function well enough to use a manual….sooooo what do we do for everything else on this earth we plug it up to a battery and leave a carbon footprint with the magic of combustion….viola…she can move on her own accord. Freedom.

Yes she is a member of my tribe. And yes I have flashbacks to being about 12 and having every last aspect of my day to day living performed for me by my mother and it was humilating and I was at home and my mothter is one of the most generous, gracious, loving people I have ever known. Yes my plan is not so much medical but tribal.But I am still right.

And its more medical than you think. Do you know why she still has pneumonia after a month of antibiotics because she is stuck in bed all the time….this is a basic evidence based principal people.  Would you be depressed if you spent your whole life in bed with the occasional respite to chairs that others pushed and moved at will??? in a place away from your loving spouse of 51 years???  being taken care of by (per patient) people who just don’t care… Do you really think our magic drugs are going to heal that sort of hurt? This is not a chemical inbalance its desperation.

how different is it to lock up this old lady in a bed than it is to lock up an infant with Downs syndrome in a crib for the first 10 years of his life?

its different because this is America and this lady paid taxes and worked her whole life, raised two kids and this is the best we can do for her as a society.

rounds will be fun tomorrow…I will say the words rehab re-evual, power chair and medicare….people will stare then give me the look of quiet superiority of being (translation: they might well pat my head and say aww look at the cute little baby doctor in the wheelchair isn’t she inspirational…or well there you go see this is why we need diversity in medicine…what a nice perspective..thanks but its hopeless) and go back to the endless tirade of anti-depressants and antibiotics.

… thank God I only have 4 weeks of internal medicine…I am tired of taking care of problem lists with people attached.

I realize more and more that somewhere down the line I decided my allegiances to the tribe of disability and illness was higher than my allegiances to medicine.

Dad  keeps telling me I need to drink the kool aide.