Saturday, November 12, 2005

I am working today as a hospitalist. About 8 days ago, I was working in the ER and saw Mr. Jones. (Name changed to protect...well, me, I guess.) He complained of abdominal pain, nausea and vomiting, and constipation.

His abdominal CT showed a huge fecal impaction in the left lower quadrant. He also had a hemoglobin of 6. For those of you in Rio Linda, that's very low.

No significant past medical history and no current medications. No significant use of NSAID's or alcohol. No complaint related to GI bleeding.

Anyway, admitted to the hospitalist service and transfused. Became hypotensive while receiving an enema and transferred to the ICU. Elevated cardiac enzymes led to the diagnosis of NSTSE MI.

Ended up being diagnosed with chronic kidney disease with acute renal failure and some renal tubular acidosis. Refused endoscopy. Refused cardiac cath.

As I was discharging him today, we were talking about future care. I wanted to share with you what he told me:
You know what, Doc? I am 4 months short of 80 years old. About 5 years ago, I was sitting on the driveway with my brother. I was sitting cross-legged on the concrete. I arose without any particular difficulty and my brother said, "Boy, I hope I am as healthy as you are when I am your age."

I told him that I probably had 5 or 6 serious things wrong with me that I didn't know about. After all, I was pretty old and those things happen as you get old. Now I'm finding out about them.

I have an incredibly good life. I have had great jobs. And I've got this wonderful red-head right here. [gestured to his wife] I don't have any regrets. Sure, there were a few bad points, but no big deals. I certainly wouldn't change anything.

I guess it's just time for me to deal with the medical problems. I'm ready.

I was amazed that his wife was able to keep from crying. I almost did. She just reached out and stroked his face.

It is not that unusual for patients in their late 70's and older to say that they are just done. Ready to go.

So many people are searching for the key to aging and ways to extend life. For a while, in the latter half of the 1900's, medical science made great strides in extending the average life expectancy of Americans. This was done mainly by preventing the death of middle-agers. They then lived for 10-20 years with severe medical diseases that would have killed them 50 years earlier. But they don't live into their 80's and up.

The people that now live to be 80's and up are the same people that would have had long lives 50 years ago. They just aren't that sick. They live to see the things they are used to go by the wayside, their friends (and often, their children) have died and they just get...I guess tired and bored is a way to say it. As Mr. Jones said, "I'm just done."