No. 10: My patient was abandoned by her family

7 Minute Read
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Intern Year:

“The problem is… you don’t have enough sex,” said my patient as I helped her back into bed.

“ExCUSE me?!” I spurted incredulously, watching her as she chuckled. She was an 80-something-year-old, spunky, olive-toned woman with silvery white hair she wore in a long braid down her back. She demanded I call her by her first name (we’ll call her Margie), referred to her late husband as her “Old Fart”, and sported deep smile lines to match the wrinkles around her eyes that let me know she had spent much of her life laughing. 

“You. Don’t. Have. Enough. Sex. Dear. I can tell because you’re so uptight. I can imagine it’s not easy dealing with old bags like me every day, and sex would help you relax,” she sighed. “I wish I could do it more, but it’s been about 7 years since my Old Fart died, and somehow I feel like sleeping with one of the nursing home fellas would be cheating on him in a way, you know?”

“I don’t know, Margie,” I smiled. “I’ve never been married, so I don’t know how that would feel.”

“Never been married?!” She sat up and looked at me carefully. “Hmm. I don’t understand that. I was working on my second marriage by the time I was your age. That one didn’t work either by the way. They are right when they say ‘third time’s the charm.’ Old Fart was the love of my life.”

I laughed. “Guess I need to get started, then.”

Watching her joking with me that day, it would be hard to imagine that just a few days before, she had been knocking on death’s door in an ICU bed. Margie had been admitted to the hospital about a week ago with confusion and a high fever, coming from a nursing home in the area. She smelled like she hadn’t been washed in awhile. When asked what year it was, she had slowly grinned and slurred, “1969”. When asked where she was, she had rolled her eyes and said “Obviously with the wildebeests.” A CT scan of her head showed no evidence of an acute stroke or brain bleed to explain her confusion. Her blood work revealed a very high white blood cell count, indicating that she likely had an infection somewhere that we needed to discover. A urine sample was negative for signs of urinary tract infection. Upon careful full-body examination, we found that she had a large pressure ulcer (or bed sore) on her lower back that had become infected. Her blood cultures were positive, indicating that the bacteria from the ulcer infection had entered her blood stream, making her very sick. 

She improved slowly, but consistently, with proper wound care and IV antibiotics. By the 3rd day of antibiotic treatment, her mental status improved, and I was pleased to find that in her right mind, she was jolly and quick-witted, with a new story about “the good old days” for each time I entered her room. It was a pleasure to see her everyday, and I often stopped by her room before I left the hospital at the end of my shifts. 

One of the first questions I asked her when her mental status came back to her baseline was “Is there a family member or friend I should call to tell that you are here?” The sparkle immediately left her eyes as she told me she had a son that lived out of state, but he likely wouldn’t care that she was there. I responded by asking if she would like me to call him just in-case, thinking there is no way he won’t care; his MOTHER is 80-something and in a hospital bed! She gave me her son’s number with a deep sigh.

I settled at my computer station prepared for a lengthy phone call with the patient’s son. Patients’ family members often had loads of questions to ask when their loved one was in the hospital, and Margie had been admitted for almost a week. I imagined I would have to explain everything that had happened to her in the ICU, and what the plan would be moving forward.

The phone rang 5 or 6 times before Margie’s son picked up. “This is Curtis,” he answered matter-of-factly, with a tone that suggested he was a busy man. I went on to introduce myself and explain that his mother was in the hospital, and was very sick, although better than when she presented. Curtis asked “How do you think this ulcer developed?”

I picked my words carefully before answering. While I didn’t want to accuse any particular person or group, I let him know that these sores tend to appear when patients are not mobile on their own, and sit or lay in one position for hours on end. When he asked me if it was the nursing home’s fault, I said “Well, they likely weren’t making sure she turned in the bed frequently enough, but it’s hard to say.” I don’t know why I’m sugar coating this for him, I thought. They definitely dropped the ball on this. If they had been properly washing her on a regular basis, she would have been brought to the hospital for this ulcer weeks ago.

“Oh man,” Curtis breathed. “I knew I should have gone to check in on her. I’ve just been so busy over the past year or so. How is she now?” 

Past year! He hasn’t seen her in a year?! I made sure my voice was devoid of astonishment when I replied, “She’s doing much better, but still very sick with a blood-stream infection. If you would like to reach her, you can call the nursing station and ask for room 402.”

“What do you think we’re looking at life-expectancy wise?” He asked after shushing what sounded like a co-worker calling him back to work in the background. 

“It’s hard to say,” I responded. “We can treat this infection with antibiotics, but she will likely get infected again if that ulcer doesn’t heal. It’s located in a place that gets soiled with stool easily because it is so close to her rectum. Some patients even need surgery on their bowels and lower back to promote healing of the ulcer and prevent further infections. At your mom’s age, though, she may not feel up to doing any major procedures.”

“I have too much on my plate to think about all that right now,” he said shortly. “What’s the best next step?”

Okayyy, rude. “We will treat her with antibiotics and turn her every two hours while she is in the hospital. It will be very important that she doesn’t lay on her back for too long once she goes home.”

“Alright. Thank you, I’ll call my mother in a little while.”

Later in the afternoon as I was visiting Margie before leaving the hospital, her bedside phone rang. It was Curtis. I said to Margie that I would step out and give her privacy, but she shook her head and motioned for me to stay, placing the phone on speaker because she was too weak to hold the phone for a long time. She seemed nervous talking to her son, as though saying the wrong thing may push him off the phone sooner. The conversation lasted 2, maybe 3 minutes before Curtis ended with, “Talk to you later, mom. Really. I have to go now.” The tone of his voice was steeped with annoyance, as if to say “Please don’t disturb my living with your dying, mom.” Margie hung up the phone, and her eyes welled with tears. “That’s the first time I’ve spoken to Curtis in over a year. I doubt he will call again. He’s busy with his life, I get it. I just miss him, is all.”

It was at that very moment that I realized – I was judging her son. HARD. In my opinion, he was abandoning his mother. These thoughts were wrong, I knew. In general, I tried not to be judgmental of patients or their families. I had not lived their lives, I did not know or understand their struggles or the situations that caused them to make the choices they made. However, in that moment, I simply couldn’t fathom the circumstances that would have to take place in order for me to abandon my mother in the hospital in her old age. Especially not when I knew it was likely neglect that landed her in the hospital in the first place.

Patients’ families were all so different. There were some that were overbearing (like the patient’s family member who I foolishly gave my cell number to), and others like Margie’s who didn’t show up at all. I thought of all the other elderly patients I had seen before her this year. There was the lady who was found in her apartment by a neighbor two days after falling and not being able to get up (she survived), the man whose family we were never able to reach to notify of his death in the ICU, and the countless patients that we jokingly referred to as “residents” because they basically lived in the hospital for weeks to months because they had nowhere to go after discharge. Many of the “residents” never got a single visitor while they were hospitalized. It made my heart so sad. 

On my way out of her room, Margie reminded me, “Get started on finding husband number one. And if you think you’ll actually keep him, make sure he’s younger so he can sit around in the hospital when your ungrateful children abandon you.” It was the saddest of jokes, peppered in loneliness. I silently promised myself that I would continue to go out of my way to make her feel cared for, as well as any other patients who didn’t have family coming to visit. 

Until next time,

Dr. Oye