June 9th, 2007 by Dr. Val Jones in True Stories
Tags: Alzheimer's, Geriatrics, Personal, Psychiatry
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My grandmother was a kindly woman. She grew up in a frontier town in Alaska, the daughter of
a photographer. She lived simply, and
spent the majority of her waking hours figuring out how to stay warm. Much to her delight, her mother eventually
moved to San Francisco,
where she was able to thaw out and bloom.
She went on to marry a charismatic business man (one of the
early founders of Technicolor Films) and had 6 children, the first of whom was
autistic. It was a great challenge
taking care of all those kids, with her husband away on business much of the
time. And there were no special services
for children with autism then. So it
came as no surprise when my grandmother seemed a little forgetful and frazzled. But that forgetfulness was not so innocent as
it turns out.
Memory lapses grew into more advanced confusion, as her
children noticed that she was becoming unreliable. She would forget to pick them up from school,
couldn’t remember where they were going next, and didn’t recall what they had
told her only moments prior. My
grandmother had early onset Alzheimer’s disease – and it would take her on a
path of no return.
By the time I was old enough to know my grandmother she was
being cared for by home health aids. She
was still extremely sweet and gentle, and could have short conversations that
were interesting and engaging, but she had no idea who I was, or why we were
speaking. Still, her Victorian
upbringing caused her to be extremely well mannered – never letting on that she
secretly wondered why this “nice young girl” (a perfect stranger) was spending
time with her in her house.
But the strangest part of grandma’s journey with Alzheimer’s
was that it took her on a reverse tour of her former life. She seemed to be reliving each day that had
had the most emotional impact on her – in descending chronological order. So that some weeks she believed that each day
was her 60th birthday… and then she’d move on to each day being her
58th birthday, and so on… But the most heart-wrenching span of weeks
were when she thought it was the day of her husband’s death. She wept all day long, reliving the
experience. We would ask her why she was
crying, and she’d look at us incredulously, “Well, don’t you know that Kay died
today?” Our lack of appreciating that
obvious fact added to her extreme loneliness… as if she had lost her husband
and no one else cared or noticed. We
would try to dissuade her of that notion, reminding her of the actual date and
who each of us was. But alas, the
neurons that housed her emotions seemed to outnumber those that ordered her
memories, and so only time could change her of her perception of reality.
We all watched grandma deteriorate over the years, being
dragged backwards through time by some invisible force, verbalizing her
experiences as she relived them. It was
a kind of bizarre way to learn about her life – through the eyes of a woman who
told old stories as if they were currently occurring.
But eventually the stories ceased, and she regressed to a
non-verbal state. Her mind had finished
its story telling long before her body was ready to let go.
Grandma lived until the age of 96, and passed away
peacefully in her sleep. I can only hope
that she was dreaming of pleasant events in her early childhood when she
slipped into the ether – a baby in a shadow of memory.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 26th, 2007 by Dr. Val Jones in True Stories
Tags: Medical Training, Parenting, Women's Health
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Even though the gender gap in medicine is closing quickly (about 50% of medical students are female), young female physicians in practice are often viewed with suspicion. Dr. Michelle Au, an anesthesiologist and graduate of my alma mater, is regularly asked if she’s “a real doctor” or if she’s the nurse or a student of some sort. This week she blogged about her experiences, and there was a large volume of interesting responses.
I myself have had a rough time of it in the past (now I guess I look old enough to “be a real doctor”), and was routinely assumed to be a nurse, physical therapist, or even pharmaceutical rep. I actually wasn’t that offended by being miscast – mostly because I took it as a compliment not to look like a doctor. Although it’s somewhat unclear what a real doctor is supposed to look like, I have a feeling he’s older, balding, and paunchy.
But one day I was a little annoyed when my age and gender was equated with incompetence, which crosses the line for me. Here’s how the conversation went between me and the parents of a toddler with a small cut on his forehead:
Me: “Hi, Mr. and Mrs. X, I’m Dr. Jones. I see that Johnny bumped his head and will need a few stitches.” [Enter long history and physical discussion here].
Mrs. X: “Are YOU going to put in the stitches?” She asked nervously, scanning the ED for other physician suturing candidates.
Me: “Yes, I assure you I will be very careful. I’ve sutured many similar lacerations.”
Mr. X: “Yeah, but don’t you think he needs a plastic surgeon?”
Me: Looking at the small cut that only required 2 or 3 sutures. “I understand that you want the best possible cosmetic outcome for your son, but I assure you that this cut is so small that the plastic surgeon wouldn’t close it any differently than I would.”
Mrs. X: Spotting a tall, male intern fiddling with some bandages on a supply cart. “Well, can’t he do it?”
Me: Viewing the clumsy medicine intern. “Well, yes, he could. Shall I ask Dr. Big Hands if he can come and suture your son’s forehead? He’s never closed a lac before and has been dying to try one.”
Mrs. X: Um… Well, maybe you should just do it.
Outcome: I did a beautiful, delicate job of closing the small laceration, and the parents watched in awe as I used the tiniest needle and thread to create a seamless finish.
Mr. X: Thanks for your help. You did a really great job.
Have any of you readers had similar experiences?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 19th, 2007 by Dr. Val Jones in Medblogger Shout Outs, True Stories
Tags: Cancer, Disabilities, Surgery
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Although these 3 stories are incredibly sad, they serve to
illustrate the realities of this imperfect world – and how heavy some “crosses”
are for people. We should count our
blessings when things go right for us, and reach out to those who are suffering
in unimaginable ways…
From Hallway Four: A
40 year old woman was seen for difficulty breathing and eventually diagnosed
with pneumonia and fluid-overload secondary to need for dialysis. This
lovely lady had been diagnosed recently with kidney cancer of her right kidney
and had undergone nephrectomy (removal of the diseased kidney).
Ordinarily, this would still have left her with one good kidney, which is all
you need. But, as luck would have it, this lady had donated her left
kidney to her ailing sister three years prior.
From Charity Doc: A father of a 7 y/o little boy brings him
into the ED last night reporting that his mother’s boyfriend had beaten him
black and blue with a belt, an assertion that the mother did not deny. The couple had
been divorced for a little over a year. On physical exam, the little boy had
indeed not been spared the rod at all. His buttocks and back were ecchymotic,
black and blue with scattered scabbed marks from numerous whippings and
beatings. It was unbelievable. [Child
protective services ruled that the child should go home with the mother
because] the mother has legal custody of the kid and we can’t send him home
with his father.
From a story relayed at a Rehabilitation Medicine
conference: A set of conjoined twins were born fused at the hip. They were sickly, sharing a circulatory
system that was insufficient to serve both of their needs. The doctors had to make an educated guess as
to how to dissect the two apart from one another – there was only one set of
male genitals, and three legs. They
carefully studied the anatomy and decided to part the twins, giving the
healthier appearing one two legs and the genitalia, leaving the other with only
one leg and no genitals. Several weeks
after the surgery the first twin (with the 2 legs) died. The second twin is still alive, is in his 20’s,
and has been in and out of jail for drug trafficking.
Makes our own problems seem pretty trivial, doesn’t it?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 18th, 2007 by Dr. Val Jones in Medblogger Shout Outs, True Stories
Tags: Animals, Emergency Medicine, Hospitals
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Thanks to GruntDoc for posting a link to a heart warming story of a cat rescued by an EMS team in Britain. Firefighters and ambulance crews were called to the scene of a house fire, and fortunately found no people inside. They did, however, find the family pet – suffocating, wet and terrified – and brought the poor cat out to the street where they administered some oxygen. Unsure of next steps, the crew asked for permission to transport the animal to the nearest 24 hour veterinarian hospital. Being that there were no humans in need of the ambulance at that time, they were given permission to call ahead to the animal hospital and hand off the kitty to the vet team, who proceeded to save her life.
Let’s hear it for the compassionate EMS team who took the time to be kind to all creatures great and small…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 14th, 2007 by Dr. Val Jones in True Stories
Tags: Parenting, Pediatrics, Personal
2 Comments »
I was reading a touching post in Fat Doctor’s blog about her
son – how she wanted to protect him from mean kids who would inevitably hurt
him at some point along his school career.
She spoke about how painful child vs. child cruelty can be, and how some
of us carry those wounds and insecurities into adulthood.
I was a bookish little girl, pudgy with pale skin, freckles
and braces… unathletic but enthusiastic.
Our gym teacher liked to begin each class by appointing two team captains
and allowing them to choose teammates one after the other until everyone had
been assigned a team. So whether we were
going to play softball, floor hockey, basketball, or any other sport, it always
began the same way, two captains vying for the top athletes to build a team
that could crush the other.
The outcome was predictable.
The top “jocks” were usually selected as team captains, and they
proceeded to invite their favorite friends to their team, followed by the
mediocre kids, and finished with the chubby or clumsy kids at the end.
I was usually chosen second to last. But there was one little girl who finished
last every time – Tina Appleberry. She
was book smart like me, but although she wasn’t chubby, she had poor eyesight
and thick glasses and was rather uncoordinated and fearful of balls. Most kids didn’t like Tina because she was awkward
and unattractive. And I used to watch
her facial expression as she listened to the reticent team captain calling her
name last… because there was no one else to call.
Tina was a sad girl, and the years of being selected last
for sport teams had taken a toll on her.
She lacked self confidence, she was easily embarrassed, and she fully
believed that she wasn’t worth much at all.
I felt so badly for her… and shared her pain. Being second to last wasn’t that much easier
– and I loathed gym class. I would try
to get my parents to write as many excuses as I could think of to get out of
it, so I didn’t have to suffer the humiliation of my peers testifying in unison
that I was nearly the worst person in my grade at sports.
One day we had a substitute gym teacher. She clearly had no idea who the jocks were or
what the pecking order of kid selection was supposed to be. I was putting on my sneakers in the corner,
wishing that I could be invisible, when she walked up to me and announced that
I would be a team captain that day.
There were sighs and snickers as I followed her to the middle of the gym
floor and stood next to the class’s top jock, Johnny Tanner. The rest of the class lined up in single file
in front of us so we could see our range of choices.
The teacher told me to choose first. I surveyed the children lined up against the
wall, eyes fixed on me, eager to see who I’d pick first. I paused.
“I call Tina Appleberry,” I said. And you could have heard a pin drop. Tina almost fell over in astonishment. She slowly walked towards me to stand by my
side, lopsided pigtails and all. I
smiled at her, she smiled back. The
other kids didn’t know what to make of my choice – some thought I was stupid,
others thought I didn’t understand the rules (that you choose your favorite kid
first). But that day I knew that I had
won a small victory – a victory that outweighed the sum of all gym game
outcomes in grade school. And I can only
hope that Tina remembers that she was not always chosen last –and that her childhood
wounds are a little less deep because of that day.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
