She’s terminal, there is no denying.
She said with no tears and no sighing,
Really it’s fine
I know that it’s time.
Doctor, I’m sure I am dying,
The two identifiable patients I discuss here gave permission to write about them.
A man whom I hadn’t seen before had a pain in his left calf. He was the third patient that day with leg pain.
Working his cattle a week ago, one of new calves butted him pretty hard. Since then he had increasing swelling, pain, bruising and tenderness in the left calf.
He didn’t have any other risk factors for blood clots, but I could see his lower leg was black and blue and swollen. I had him put his heel on my knee, then I grasped his foot with my right hand, and while I squeezed his calf with my left hand, I pushed his foot up. I didn’t have to ask if it hurt, I could see it on his face.
“Positive Homan’s sign,” I said. Then I had to explain about eponyms. Homan only did one memorable thing in his medical career, and that was to give his name to a physical diagnostic sign that points to a blood clot deep in the veins of the calf. Doctor language has a lot of terms relying on someone’s name, the term having nothing to do with what the disease really is. For example, most English speakers recognize the term Alzheimer’s disease, but the name carries no clue that it refers to a particular kind of dementia.
Another patient the same day came in with pain under the front right ribs, and radiating into the back. I was able to come up with the term Boas’ sign: increased sensitivity to pin prick in the segment that sends nerves to the gallbladder. Too esoteric a term even for conversation between doctors, I didn’t use it when talking to the surgeon. I did use the terms heel sign, psoas sign and bunny hop (abdominal pain, respectively, when the heel is struck, on flexing the right leg towards the back while pushing on the hip, and when hopping up and down on one foot); those words rate usefulness because the name includes a description of the test.
I sent the man with pain in his leg to ultrasound to look for deep vein blood clots.
Before he left he told me he’s retiring from his current job of 33 years in June, and he’ll go into farming exactly as full-time as he wants to.
I will let the patient who followed speak for herself:
“Well I went up to see the new young doctor that took Dr. Tan’s place and I almost cried, you know both of you at the same time was too much. I know she didn’t retire but I’m sorry she’s gone. I have a nice new young doctor, I don’t know if I’m going or not. He had been having me drink 8 glasses of water a day, and she had too and that seemed to keep me pretty level but for the last the month he wants me to go down to four. It’s not doing what it’s supposed to, it’s getting worse, it’s down to 30.
“It does not look good. And I think this is the solution, I think I’m near the end of my problems. I think I’m close to dying now. And I really don’t mind it. I had one time here after I talked to him I came back and felt terrible for about ten minutes but I really felt like it was my time. I’ve always said I would go when I needed to and I don’t want dialysis. I need to be with the Lord. I’ll miss my friends, but there’s no one who can’t live without me. You have to have a feeling that you are absolutely necessary but I don’t have that feeling and it’s OK, I don’t much care. It’s like you’re going on vacation. It’s good that you can do that and not feel guilty. We’re both in kind of spot where we need to be. My son and his wife didn’t take vacations and all of a sudden they’re taking vacations, he’s 61 and their children are gone and you have to realize that, that you’re not going to live forever. Bill and I had a time when we were never gone from the office, we never took a vacation. I remember when he was dying, there was about five minutes there and he was just as clear as could be and he said, ‘Now don’t be too long,’ and then he died. Those were his last words to me and that was a year and a half ago. I know I’ve gone longer than we thought I would but I think my time is getting close and I want to be with him.”
I sat and I held her hand. We didn’t need the Kleenex. She will probably die in the year that I go walkabout. We discussed pain control. I determined that she wasn’t depressed, just realistic in her outlook. I’ve known her for more than 20 years, and it was probably our good-bye visit.
My cell phone vibrated and I stepped out to take the call. The man with the pain in his calf did not have a blood clot. By phone I told him about rest and elevation, but his current job, from which he’ll soon retire, involves a lot of standing. I considered the whole picture, and as I thought he said, “You know, I’ve got a lot of accumulated sick leave.”
I told him to come in and pick up a back to work slip for ten days in the future.
I needed a lot of Kleenex for the last patient of the day, with mysterious pains that haven’t yielded to a firm diagnosis. “I feel like a hypochondriac,” the patient said as I wrote orders for more diagnostic tests.
“You want to be a hypochondriac more than you want any of the diagnoses I’m looking for here,” I said, “Remember that. At the end you want to shake your head and complain about all the money I wasted and couldn’t figure out what was wrong. We do not want me to be right.”