Tuesday, January 30, 2007

At the Gastroenterologist

I met her at the gastroenterologist's office. With diabetes, emphysema, astronomically high triglycerides, reflux disease, and depression with psychotic features, her mental illness and confusion frequently preclude her ability to understand the goings on during crucial medical appointments. I felt it was important for me to be there.

"I'm so nervous about this" she says. "I'm always so nervous at appointments."

We sit in the exam room and wait for the doctor. We review her diet, making lists of foods she can buy at the grocery store that are low in fat, low in sodium, and sugar-free.

"This diet's no goddam fun," she grimaces. "But I'm trying so hard."

"Well, your triglycerides have come down from 1400 to 400. You're doing great!"

"It came down 1000 points? I'm so thrilled!" She smiles broadly.

She's still beaming when the doctor enters hurriedly, his arms filled with charts and radiographic films. He dumps it all onto the desk. We shake hands, and I remind him of our previous encounters. He shakes my patient's hand, sizing her up and opening her chart.

"Sorry I'm late," he says as he settles into his chair. "One of my partners fell out of bed and broke his arm this morning. I'm picking up the slack for him."

"Talk about getting up on the wrong side of the bed," I say. He smirks.

After a quick review of my patient's history and a cursory physical exam, he looks her in the eye. "Well, with diabetes, reflux, emphysema, and those triglycerides, we have to do some tests. Basically, we're going to scope you from one end to the other." He smiles.

"Are you kidding? Do you have to?" She's incredulous and looks to me for support or possible rescue. I smile and nod and will obviously be of no help to her in the rescue department.

"Look," he says. "You're sixty, have never had a colonoscopy, and have reflux disease and diabetes. We have to make sure your colon's healthy and your esophagus isn't damaged. It's simple, but the prep isn't, I know."

"You're tellin' me!" she retorts. She looks like a cornered rabbit. We both look back at her, silent.

"OK, OK, I'll shit my guts out, all right?" She smiles and puts her head in her hands.

"That's my girl!" the doctor exclaims as he rises from his chair and gathers the pile of charts and papers and films.

As we walk up the hallway towards the reception area, the doctor a few steps ahead, I put my arm around her shoulders. "You're doing great, and I'll help you through this, OK?"

"OK," she replies, hand patting my back.

We receive the appointment, the prescription for the powerful laxative that will purge her bowel, and other instructions, and we walk down the three flights of stairs to the building's entrance. (She's trying to get more exercise, as am I.) I call the taxi company to take her home where she can continue to stew about the impending colonoscopy and endoscopy.

"Thanks for everything, Keith. I know you're busy and have alot of patients. I appreciate you coming and everything." She gives me a quick hug.

"My pleasure. Sorry this isn't going to be so pleasurable for you."

"Oh well. Bringing my triglycerides down 1000 points sure is something to smile about! I'm really gonna keep trying hard." She smiles.

"You take care. I'll talk to you soon, and don't worry."

I wave and walk towards my car. The air is cold, but there's a warm glow in my heart.


Anonymous said...

Quoth Charlotte - sideways: "Some Nurse"

Expert at work. Read, admire and emulate!

Surgeon In My Dreams said...

The air is cold, but there's a warm glow in my heart......

And well it should be! I know how I would feel if I had someone to go through stuff like that with me.

Not to sound ignorant...but could you tell me in simple terms what this would look like....depression with psychotic features.....?

You're welcome to email if you would like to answer, but not as a comment.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Thanks for both of your comments. Ms. Surgeon, I will write you privately, but Googling "depression with psychotic features" will bring up some very good info.

Ms. N=1.....my humble thanks.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Dear Ms. Surgeon,

I unfortunately cannot find your email nor can I access your blog from your profile. Thus, I am forced to respond to you here contrary to your request. My apologies.

Depression with psychotic features is a depression which has aspects of delusions or hallucinations. As stated on Medline, it involves a depression in which there is some aspect of loss of contact with reality, whether transient or more long-term. The person may hear voices which are directly critical of the self, or may see things that are not truly there. Very disconcerting, and can often further damage relationships, ability to function in the world, and further isolate the depressed person.

You can feel free to email me if you want to chat more about it.

Mother Jones RN said...

You're a wonderful nurse, Keith.