In a little bit more than three weeks on general medicine at the VA, I've come up with a quantitative system for determining how pitiful an old person looks.
Here's how you do it: You take the percentage of the old person's face that you can see on a chest X-ray, and that's exactly how sad they look on a scale of one to 100. It (maybe) works, it's (relatively) cheap and it doesn't even involve (complicated) mathematics. Call it the Objective Lacrimosity Datapoint-OLD for short.
Mr. J was one of my patients, and he had an OLD of nearly 100.
He had a bad case of dementia, and his prostate cancer had metastasized until it blocked off both of his ureters, the little tubes that connect the kidneys to the bladder. Because having both of your ureters totally blocked off is painful, he had tubes placed to drain his kidneys through holes in his skin. When he wasn't in the hospital, he lived in a nursing home.
One night, Mr. J showed up at the hospital because one of those tubes had fallen out. I followed the residents down to the Emergency Room to see him. He was sitting in his wheelchair, hunched over with his head almost between his knees like an elementary schooler in a bomb drill. He wore tan velcro shoes, brown corduroy pants, a plaid short-sleeved shirt and a black "World's #1 Grandpa" hat that was about two sizes too big for him.
We asked him if we could see his back (that was where the tubes came out). He shook his head and said "No," except he couldn't really speak. Instead, he just shook his head and made a noise like a sheep, which the residents and I interpreted to mean "No."
Just then, the residents were called out of the room. I had kind of zoned out, so I was left in the room with Mr. J. I looked at him; he looked at the floor. I went to my go-to move when stuck in an awkward situation with a patient, which is to say, "So, how are you?" No response, of course. "I see you're the world's number one grandfather," I continued. Again, no response. Clearly, I was operating under the assumption that the cure for dementia is asking the right question.
I continued talking to Mr. J until the residents came back, because I had nothing better to do and because it was an awkward situation. When the residents asked Mr. J to lean forward the next time, I offered him my hand to hold so that I could help him. To my surprise, he took it and leaned forward.
Just as we suspected (and we suspected it because we were told it), one of the tubes had fallen out. We admitted him to the hospital to get him fixed up.
(The VA hospital is like an auto repair shop for old people. They come in broken, and the doctors fix them, but they're not really repaired, just tuned up enough so that they can safely hit the streets. Of course, once they've gone into the shop once, it's pretty much guaranteed that they'll need to be back eventually.)
From then on, any time that we went to see Mr. J, he'd make his sheep noise whenever we asked him a question. Sometimes, he'd pull his blanket up over his head because it was cold in his room, and I'm pretty sure you have to personally ask Barack Obama if you want to adjust the thermostat in any of the rooms in the VA.
But when I held Mr. J's hand or put my hand on his shoulder, he became more cooperative. He stopped baaah-ing, pulled his blanket down, and let us look at his back. He even let me draw his blood once or twice.
By the time we sent Mr. J back to the nursing home, he was saying, "Pretty good," when we asked him how he was doing every morning. The medical student in me says that his newfound loquaciousness was due to the fact that his fever was gone, but I'd like to think that he was just messing with the residents and me when he came to the hospital because he didn't like us too much.
By the time he went home, I'd like to think that he even started to like us a little bit. Maybe we sent him home looking pretty much the same-chin on his chest, OLD through the roof, pretty much unable to communicate-but feeling just a little bit happier.
Alex Fanaroff, Trinity '07, is a second-year medical student. His column runs every other Thursday.
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