Sick young men


 

In came the sickest of blokes,

He drinks, he gambles and smokes

Before he’s wise or he’s sage

He’s at such a young age

And I broke the bad news to his folks.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

The clinical theme of my weekend call has run into the realm of young men with very bad disease.

Any serious illness comes with a certain sense of irony and brings drama to the family context of the patient.  Advanced age lessens drama; a heart attack in an 85-year-old doesn’t carry the same emotional weight as a heart attack in a 35-year-old.

Most of these patients have problems with alcohol and tobacco, and their sum total of illnesses reflect more their life style choices than their heredity; some of the worst problems, though, showed up gratuitously, unannounced and unexpected.

So common do the three problems of diabetes, high blood pressure and high cholesterol run together that when I transfer information from one source to another the number 3 serves as my notehand for those three diagnoses.  That single digit showed up in more than 80% of the work-ups I have done so far this weekend.

But that trifecta in and of itself doesn’t lead a person to hospitalization, but the sequelae from narrowed arteries can bring on heart attacks, stroke, coma, and respiratory failure.

As the day waned and the sky darkened, I sat and talked with a justifiably worried family about a very sick young man.  The relatives didn’t hear the implication of the possibility of a fatal outcome until I stated it explicitly, and I had to endure looks that could kill messengers.

Any family conference involves a lot of questions.  Most interviews start with questions about the illness but progress more and more to issues with emotional content.  Those last parts tax my skills as an interviewee the most, but they bring me a sense of where the person fits in the web of their family; they take a lot out of me emotionally.

An hour later, In the ICU of the hospital on the other side of town, I interviewed and examined a young man who looked twenty years older than his real age.  The things the medical community had warned him about as a teenager had come to pass.  He didn’t wrestle with existential questions, nor did he want to change his lifestyle.  When I finished with the patient, I found no family to explain things to. 

A physically sicker patient in a sociologically healthier context brings a sense of tragedy more fulfilling than that of the ailing loner.   Contrast remains the essence of meaning.

 

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