Meeting a hero
The triage nurse's note was not encouraging. Something to the effect of "85 year old male, fell, severe low back pain, unable to get out of chair x 3 days." These things are frequently nightmare cases -- either you have someone severely dehydrated and in kidney failure, septic, and terribly sick, probably moribund, or they are uninjured and well but you can't get them out of the ER due to pain, and nobody wants to admit them because there's no "medical indication" for admission and they don't want to deal with a case that medicare refuses payment on. Not the case one would choose to end the shift on, and didn't bode well for getting home on time.
Well, that's why I get paid the big bucks, right? I took a deep breath, squared my shoulders, and headed in. . .
The first thing that greeted me in the room was the strong odor of stale urine. Not a good sign. And the grizzled, unshaven face atop squalid clothing. Expectations met so far. But a pair of keen, bright eyes peered out at me from under bushy eyebrows and a big, albeit toothless, grin. He had been reading a book while waiting for me to come in! A book! After chatting with the fellow for a couple of minutes I determined he was a pleasant, extremely sharp fellow, neither terribly ill nor a complainer. He had never been ill a day in his life (a good recipe for living to 85, it must be said). After concluding the history, I went to examine him and gently picked up his book and put it aside, careful to mark his page with the bookmark. I forget the title of the book, but the bookmark was a large, glossy 4x8 photo which looked like this:"Nice plane," I commented.
"I used to fly it," he responded.
"What? Really? That exact one?"
"No, no, I flew a F model, that one's a G, but you couldn't really tell."
"Wow. What did you do on it?"
"Pilot. 17 missions."
It's hard to explain how he was transformed in my eyes after that. I so wanted to sit down with him and talk about his experiences. I am a pilot, and have nothing but awe for the guys who took off from England, flew these big beasts of aircraft, loaded with tens of thousands of pounds of bombs, across the Channel and over Germany with no navigational systems beyond a compass and a watch, dropped the bombs more or less on target, and returned home. Oh, yeah, and there were people shooting at them the whole time. They were real men.
I try to treat every patient with the same level of courtesy and compassion and all that humanistic bullshit, whether they are homeless scum or the wife of the hospital CEO, and I think I am pretty good at it. But it's pretty rare for me to really truly feel a sense of respect and indebtedness to a patient. In this case, it actually helped make the disposition easier. He turned out to have a couple of compression fractures in his lumbar spine, and despite pain medicine and his best effort, simply couldn't get up and walk. So I called up our hospitalist and began the conversation with: "Hi Jim, I have an interesting guy here. 85 years old with a couple of compression fractures in his back. He actually used to be a B-17 pilot in WWII."
"No shit?" asked the hospitalist.
"Yeah, really. Anyway, he's in pain, so I'm admitting him to you."
"Oh, of course. Send him up."
Good karma. And I got to meet a hero.
Originally posted 22 April 2007