First admitted patient.
We talked about her asthma, listened to her wheezing lungs. They were musical, singing a chord every breath she took. She told us that she had diabetes as well. Wishing to be thorough - and hoping to practice as much of the physical exam as we could in our allotted time with her - we attempted the neurological exam. Attempted, because we didn't have all the necessary instruments. We did, however, have a tuning fork. Proprioception was fine in her fingers, but what about her toes? I moved to the foot of the bed, asking her if I could remove her hospital-issued socks. Underneath, her feet were dry and cracked. Her toenails were fragile. Proprioception was not fine; she couldn't feel the fine vibrations of the tuning fork. She didn't seem concerned. She'd probably never had a tuning fork pressed to her toes before. I helped her put her socks back on and thanked her for helping us learn.
First ER patient.
She came to the hospital, on the busiest day of the year, because of the pain in her ankle. She and her home-health aide braved the crowded department with the beds triple-stacked and protruding into the already crowded walkways, because she herself could not walk with the pain. We touched and maneuvered her ankle. "Ohh!" she cried in pain. We moved her knee. "Ohh!" We manipulated her hip. "Ohh!" again. What was the problem? The ankle, the knee, the hip? Which one had caused the others' pain? But her feet were fine. I tried to find her dorsalis pedis pulse, assuming it would take several tries since I can never seem to find it even on my own feet. First try, and there it was, bounding and strong. Her warm feet were more lively, it seemed, than my own.
Second ER patient
She was in the West section, the one where those with the most serious problems are taken. My preceptor, wanting to make sure I saw interesting cases in my afternoon at the ER, asked another of the attendings if she had anything cool. "I've got a woman with a cold foot." We found her and said hello, but she was only minimally conscious and did not even acknowledge us. Still, a good teaching moment. We felt her right foot; it was, indeed, cold. And her ankle. And her calf - but not her knee. Left side was not what I would call warm, but it wasn't as cold as the right. Left was pink; right was white. No pulses on the right leg, but the femoral pulse was strong. Was it a DVT? Something else? Doppler had been scheduled, but they were unsure if they would admit her or not; they might just send her back to the nursing home. Before we walked away, I looked again at her feet. Most of the digits were hammertoes. I tried to imagine her as a young woman, wearing nothing but high heels every day. In my mind, she was happy, beautiful, fashionable, not minimally conscious in an ER bed with a cold foot. I walked away and wondered what would happen to her.
Second admitted patient
What didn't she have? We talked about her asthma, her quadruple bypass, her liver cirrhosis, her kidney failure, her ascites, her edema, her shortness of breath. Despite all of these problems, she looked at least twenty years younger than her real age, even though she had already told us about her six great-grandchildren. She had a moment of sadness when telling us of her frequent hospitalizations, and of how scared she felt when she suddenly couldn't breathe, or when her nose suddenly spilled clots of blood. I tried to comfort her despite having only minimal experience in this sort of thing. She cheered up, then commented about how hard it was getting old. I laughed, and she smiled. "She's laughin' at me, but it's true! It's hard gettin' old!" she laughed back. We began the exam, hearing her labored breathing and the shifting dullness of the abdomen. She told us she had diabetes, so out came the old tuning fork again. Off came the socks again. She looked down and commented on her feet. "I got no one to take care of my feet. Can't cut my nails." It was too hard for her to bend down that far to do it. "I look at them, and they look like claws to me!" she pronounced with a grin. I smiled back. I never knew you could learn so much from feet.
We talked about her asthma, listened to her wheezing lungs. They were musical, singing a chord every breath she took. She told us that she had diabetes as well. Wishing to be thorough - and hoping to practice as much of the physical exam as we could in our allotted time with her - we attempted the neurological exam. Attempted, because we didn't have all the necessary instruments. We did, however, have a tuning fork. Proprioception was fine in her fingers, but what about her toes? I moved to the foot of the bed, asking her if I could remove her hospital-issued socks. Underneath, her feet were dry and cracked. Her toenails were fragile. Proprioception was not fine; she couldn't feel the fine vibrations of the tuning fork. She didn't seem concerned. She'd probably never had a tuning fork pressed to her toes before. I helped her put her socks back on and thanked her for helping us learn.
First ER patient.
She came to the hospital, on the busiest day of the year, because of the pain in her ankle. She and her home-health aide braved the crowded department with the beds triple-stacked and protruding into the already crowded walkways, because she herself could not walk with the pain. We touched and maneuvered her ankle. "Ohh!" she cried in pain. We moved her knee. "Ohh!" We manipulated her hip. "Ohh!" again. What was the problem? The ankle, the knee, the hip? Which one had caused the others' pain? But her feet were fine. I tried to find her dorsalis pedis pulse, assuming it would take several tries since I can never seem to find it even on my own feet. First try, and there it was, bounding and strong. Her warm feet were more lively, it seemed, than my own.
Second ER patient
She was in the West section, the one where those with the most serious problems are taken. My preceptor, wanting to make sure I saw interesting cases in my afternoon at the ER, asked another of the attendings if she had anything cool. "I've got a woman with a cold foot." We found her and said hello, but she was only minimally conscious and did not even acknowledge us. Still, a good teaching moment. We felt her right foot; it was, indeed, cold. And her ankle. And her calf - but not her knee. Left side was not what I would call warm, but it wasn't as cold as the right. Left was pink; right was white. No pulses on the right leg, but the femoral pulse was strong. Was it a DVT? Something else? Doppler had been scheduled, but they were unsure if they would admit her or not; they might just send her back to the nursing home. Before we walked away, I looked again at her feet. Most of the digits were hammertoes. I tried to imagine her as a young woman, wearing nothing but high heels every day. In my mind, she was happy, beautiful, fashionable, not minimally conscious in an ER bed with a cold foot. I walked away and wondered what would happen to her.
Second admitted patient
What didn't she have? We talked about her asthma, her quadruple bypass, her liver cirrhosis, her kidney failure, her ascites, her edema, her shortness of breath. Despite all of these problems, she looked at least twenty years younger than her real age, even though she had already told us about her six great-grandchildren. She had a moment of sadness when telling us of her frequent hospitalizations, and of how scared she felt when she suddenly couldn't breathe, or when her nose suddenly spilled clots of blood. I tried to comfort her despite having only minimal experience in this sort of thing. She cheered up, then commented about how hard it was getting old. I laughed, and she smiled. "She's laughin' at me, but it's true! It's hard gettin' old!" she laughed back. We began the exam, hearing her labored breathing and the shifting dullness of the abdomen. She told us she had diabetes, so out came the old tuning fork again. Off came the socks again. She looked down and commented on her feet. "I got no one to take care of my feet. Can't cut my nails." It was too hard for her to bend down that far to do it. "I look at them, and they look like claws to me!" she pronounced with a grin. I smiled back. I never knew you could learn so much from feet.
No comments:
Post a Comment