A Last Admission

One of the first patients I saw in the house calls program I joined my first year in practice was 88 and lived with his wife of 65 years on the upper west side of Manhattan. He suffered from end-stage heart failure and had declined tremendously in the past year. His mind was still vibrant and his family was close by and supportive. In my first visit we discussed his recent history of multiple hospitalizations due to fluid overload where he would get tuned up and sent home – and then the process would repeat in a matter of days or weeks. As I examined him it was clear he was using all his energy just to breath. He slept in a reclining chair with his head propped at a 45 angle or more. His skin hung from his skeleton and there was swelling in all of his dependent areas, betraying the fact that despite his wife’s good cooking, he was malnourished with low protein levels. When I got to his legs you could push fingers into the swollen skin like risen bread dough, the dents remaining long after the pressure gone. The skin was shiny and red with weeping of fluid. His family was eager to get him to the oldest grandchild’s wedding in 10 days time. We made small changes to his medications and ordered home health to monitor the edema in his legs and check blood pressure as the changes took effect.

The Monday after the wedding I got a call that Mr. Berman was in the ER very short of breath and being admitted to the hospitalist service. At the end of the day I stopped in the hospital before heading home to see my patient and answer any questions. While looking at the patient’s chart I saw the hospitalist who was in charge of his care and inquired about him. “oh he is yours?” he replied “ I am so glad you are here. I have sort of being treating him like a bag of organs!” His reply shocked me. It was a clarifying moment about how medicine should be practiced. Never lose sight of the human being. 

As I entered Mr. Berman’s room his eyes brightened and his mouth formed a weak smile. The wedding was wonderful even though he couldn’t dance. He shared how tired he was now though. After talking with his wife and children, it was decided he would go home on hospice the following day and died peacefully on hospice the following week.