Monday, 30 January 2017
Respect your elders
I've strongly considered writing a post about "Things They Should Teach In Medical School But Don't", but I haven't yet for reasons I can't explain. Probably just laziness. There are so many little details about every facet of medicine that would make it impossible to teach them all without extending med school to approximately 295 years. One of the big things in trauma that I wish I had been taught in school is that old people fall. A lot. A lot a lot. When you combine failing eyesight, poor balance, brittle bones, and forgetfulness, you get either OPFDGB (Old Person Fall Down Go Boom) or AVG (Age Versus Gravity) depending on whom you talk to. Gravity always wins, mind.
A small percentage of my elderly fall victims have serious injuries like fractured hips or bleeding on the brain, but mostly they are only mildly injured, with contusions, lacerations, perhaps a fractured rib or seven. The vast majority of these patients are nice older folks who, I'm sure, would all have fascinating stories to tell if I had more time to sit down with them and talk. My grandparents died at the ages of 69, 87, 95, and 100, and some of the stories they told me about The Old Days were absolutely riveting (though I heard most of them several times). I honestly wish I could sit with my older patients and have them tell me their life stories.
But not Dora (not her real name™). To hell with Dora.
Dora was 92 years old and fell out of bed one morning, or so the medics thought (more on that later). Her daughter found her on the floor around breakfast time, and she saw a decent amount of blood surrounding her head. When the medics arrived they had to fight with Dora - literally. She swung at them repeatedly and resisted their attempts to secure her to the stabilising equipment. Even though it was barely 9 AM when they arrived, they already looked exhausted.
"Sigh. Good morning, Doc. This is Dora ("GO TO HELL!") . . . shhh! Be quiet, Dora. Anyway, this is Dora. She was found on the floor and we think she fell out of bed ("I DIDN'T FALL GOD DAMN YOU!"). Her daughter found her. She has a laceration on her head. No blood thinners. She hasn't been very cooperative ("THE HELL YOU SAY!") with us."
Dora turned her eyes to me, and I swear I've seen the same look in a Friday the 13th movie. Her eyes were small, sunken, and evinced nothing but pure malice. I think if she had a knife at that moment she would not have hesitated to use it on me. She then glanced around the room and made sure to give that same malevolent look to everyone as she muttered various curses and spat epithets under her voice.
Respect your elders.
"So long, Doc. Good luck," the medics breathed with relief as they almost ran away.
I looked back at Dora. She braced me with those tiny beady eyes as if daring me to speak. I was not about to let this little lady get the better of me, nor was I going to allow her to get the rise out of me that I thought she was looking for.
"Good morning, Dora. What happ . . ."
"GO TO HELL! GET ME OUT OF HERE! YOU'RE HURTING ME! OOOOWW!!"
I wasn't touching her, nor was anyone else. So it's going to be like this, is it Dora? Fine. Let's dance. As I approached her she held her shriveled arms out at me, revealing her nicely sharpened fingernails, trying to grab me. I examined her head, careful to stay out of reach of her talons as she tried to claw me repeatedly. She had a small laceration on the back of her head, less than a centimeter, that would require a few sutures. But bleeding in the brain can cause patients to act very aggressive like this, so I needed to make sure there was no serious underlying brain injury.
She continued cursing, swinging, grabbing, pinching, and clawing as we finished working her up and transported her over to the CT scanner. The radiology tech was helping to move her over to the CT table, and that was when it got really weird.
"Oooh, what's your name?" she cooed to the young tech with a smile that reminded me of this:
The look he gave me clearly said "Help me!"
The next few minutes were filled with the most uncomfortable flirting I have ever been unfortunate enough to witness, including Dora calling the tech her "boy toy" and asking him on a date that night. I don't think I've seen anyone shudder quite so obviously (and appropriately) before.
Fortunately the CT was negative, so all Dora needed was a few sutures so I could get her the hell out of my trauma bay. Unfortunately that was easier said than done. She pinched the nurse, slapped the tech, tried to claw me as I held her arms down (veeeery gently, mind you), and then tried to bite me when her clawing failed. Yes, she still had all her teeth, damn it. During all of this I held my tongue despite wanting nothing more than to scream at this old lady to knock it the hell off and act like an adult, rather than a spoiled toddler who didn't get her favourite candy.
Some old folks are pleasantly demented and smile nicely at everything, while others get very frustrated at not being able to remember things, and they get angry and sometimes violent. Without knowing her medical history, I figured Dora had dementia as the source of her violent tendencies.
And I figured absolutely wrong.
Her daughter came to pick her up a short while later, and she told us that Dora had always been this way, ever since she was a child. She had no psychiatric diagnoses, took no medications other than one medicine for high blood pressure, and tended to act out when agitated. She hit people, she yelled at people, and she cursed at anyone who got in her way.
In other words, there was no excuse. She was just a horrible, cruel, evil witch.
As Dora's daughter helped her put on her coat on her way out, my Inner Pessimist implanted a rather nasty thought into my brain. Maybe her daughter pushed her out of bed. After spending less than an hour with Dora, I would definitely call that justified. I can't imagine growing up with someone like that.
Dora made one last attempt to swing at me as she was wheeled out. I muttered "Good riddance" under my breath but felt slightly guilty despite her multiple failed attempts at assault. In spite of everything, my Inner Pessimist had one last fleeting thought:
Maybe I would like to sit down and ask Dora her life story. Something must have made her this evil. I just wonder what.
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