Year: 2013
Type: article
Abstract: Admitting DayA dmitting Day.Like any other, it began with rounds, but halfway through our tour of the sixth floor, a nurse approached us in the hall."The patient in room 226.She doesn't look good.I've got a temp of 103 and sats in the 70s."Lying in the dim overhead light, she looked frailer than any patient I had seen.The skin over her emaciated extremities was wrinkled like tissue paper and lined with a shimmer of cold sweat.She was shaking violently, arms flexed, eyes closed, with rapid, shallow respirations."Rigors," my resident sighed and went to examine her.I stood there watching, unable to make sense of the situation.His experienced hands moved quickly over her body, flexing each joint, palpating every lymph node, and percussing the lung fields.He glanced up at me a few times puzzled by the lack of assistance, but my feet refused to move.This was my first medicine clerkship of third year; I had never seen a woman who looked this ill, and I was terrified to act or touch her."What can we do for her?"I asked hesitantly."Let's get her family on the phone," my resident replied.Thankful for an excuse to leave the room, I went to call her family.I learned that she was a 92-year-old woman with advanced dementia and numerous comorbidities who had been transferred overnight from her nursing facility for high fever and altered mental status.Only a few days prior, she had been diagnosed with tracheobronchitis and started on antibiotics, but her decline had been precipitous.In talking with her family, it became clear that the past year had been extremely difficult, with numerous hospitalizations and long recoveries.Listening to her story, I felt compelled to console and reassure her family.I had not yet seen a patient die, and I was unwilling to entertain the possibility that she might be my first, but they were more realistic and accepting than I."Nothing dramatic," they told me."Just keep her comfortable."Her family arrived gradually over the course of the afternoon.With the advice of the medical team, they ultimately opted for "comfort measures only."No antibiotics, no telemetry, no fluids.Just let her be.With Valium and morphine, her breathing became less labored, and the rigors stopped.Her withered hands fell limp by her side, and the creases that had filled her face finally became smooth.Although relief was visible on the faces of the family, I felt myself becoming more anxious.
DOI: 10.1111/jgs.12377
Author: Emily M. Bucholz
Institution: Yale University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4232026755