My Grandfather's Patient

The Emergency Rooms of this country provide a large amount of care to the elderly who reside in nursing homes.  These patients may have their own doctors or the nursing home may have a doctor on staff, but when someone at the nursing home is sick they get sent to the ER.  Frequently the elderly patient is unable to provide any history as to their illness or injury due to dementia or their general frail state.  On those occasions, you have to do your best to assess the patient and determine the cause of their illness.  In many ways, it is just like a being pediatrician or a veterinarian.  You can't always get information from the patient.  You must use your clinical skills to evaluate them.  It is sometimes a very difficult thing to do with many complicating factors such as family issues, code status, comfort care etc.  These patients are not ones you always look forward to taking care of.  Much like the screaming 2 year old with a lip laceration; there are just some patients you would just rather not see.

I went in to see an elderly lady from a nursing home who was 102 years old.  She was sent to the ER because she had a fever and a cough.  When I went in to see her, much to my surprise she was perfectly alert and oriented.  Her mind was sharp as a tack.  Despite the frailty of her body, her mind was unfazed by her 102 years.  She was a living history book of the past century. I thought of all the things that she would have seen in her lifetime.  Two World Wars, space flight, TV, telephone, computers, many advance in medicine, CTscans etc.

I was reviewing her paperwork sent with her from the nursing home including her current medications, past medical history etc.  Included in her paperwork was a list of biographical information... her birthdate, place of birth, family contacts and so on.  I immediately took note of her place of birth.  It was the place of birth of my mother.  A small town in the Midwest that few people have ever heard about.

My grandfather came to the United States from Germany at the turn of the century.  When he came to the US he ended up going to medical school.  He set up practice in this small town.  He was the only physician for many miles in this rural area.  He ended up paying for his two brothers to also attend medical school and his sisters to attend nursing school.  The family established a clinic and eventually a small hospital in this small town.  My mother was the youngest of 16.... that's right 16 children that my grandfather and grandmother raised.  Surely this lady would have heard of my family.  My mother passed away when I was 16.  Trying to do the math, I figured my mother was about 30 years younger than the patient I was seeing.

"I see you are from Ironwood*."
"Yes. I spent my whole life there and didn't move here until my husband died.  I moved hear to live with my daughter, but several years ago became ill and I have been living at Green Farms Home*".
"My mother was born and raised in Ironwood*".
"What was her name?"

I proceeded to tell Alma* my mother's name and about my grandfather.  I asked if she knew them.  Her eyes lit up.  She said "Why of course!".  "Your grandfather was my doctor and delivered two of my children. Your mom used to play with my kids".

We spoke for some time about her memories of my mother and grandfather.  My grandfather died before I was born, so I obviously never had the chance to meet him.  It was wonderful to hear Alma* tell me what a kind and caring doctor he had been.
I lost my mother at the age of 16.  That was a terrible thing to go through.  I always thought my mom would have been so proud of me for following in her father's foot-steps.  It was such a touching gift for Alma to tell me of my mother's childhood. " What a happy, pretty and smart girl she was", Alma said.  It made me sad that I could not share this encounter with Mom, but I could not wait to get home and call my family to tell them of  this chance encounter.  To think my grandfather had been Alma's doctor when she was a young woman having a family and now I was here to provide her comfort and care towards the end of her life.

That was only time I ever saw Alma.  She brought me closer to my mother, my grandfather and had profound impact on me personally and as a physician.  My Grandfather's Patient.