Portal de Periódicos da CAPES

Memorable Moments

2006; Lippincott Williams & Wilkins; Volume: 28; Issue: 1 Linguagem: Inglês

10.1097/00132981-200601000-00036

1552-3624

Rani K. Kumar,

FigureIt was another busy day in the emergency department. Hallway beds were the closest thing we had to private rooms, and patients got everything short of rectal exams there. The waiting room was bursting at the seams, and the entire hospital staff was trying to move patients out of the ED. The hospital census was more than it had been in a long time. Administration had gotten the message that a lack of nursing staff was a cause of emergency department bottlenecking, and the agency kept us well staffed with nurses. Beds, however, were another story. The hospital had opened 20 more beds than its license allowed, but the Department of Health was good about permitting the emergency needs of sick patients. In short, it was a routine ED day. The high volume had persisted for several months, each day more overwhelming than the one before. The staff members working in this relentless chaos found themselves exhausted at the end of their shifts. Today was no different. It was close to the middle of my shift, and I was already looking at the clock: five more hours to go. I felt an acute caffeine insufficiency, but there was no time for a cup of tea. I picked up the next chart, seeing triage notes that read, “Confused for a year.” I had just finished stabilizing an overdose patient who required intubation, and rushed an acute MI patient to the cath lab. I could use an easy patient next. But before I could reach her room, a colleague asked if I could help him with a patient. His patient had a bad laceration that was pumping blood all over. I heard someone say in a soft tone, “It's a patient with confusion for one year. I guess she can wait for a few minutes.” I smiled a little as I donned protective gear to assist my colleague. When I finally reached my patient's room, I saw an 84-year-old woman sitting comfortably in bed. She was a beautiful woman with a glow on her face. Her daughter was sitting on the chair, anxiously waiting for the doctor. I introduced myself and sat momentarily next to the daughter, who told me her mother, who lived alone, had been growing more confused over the past year. I asked if there were any acute changes that brought her to the hospital that evening. She said her mother had left the stove and oven on, and was talking to imaginary people. She asked them to stay for dinner. When she saw her daughter, she repeatedly asked her to get a basket of flowers for her sick neighbor, and said she had cooked a meal for the neighbor and left it in the oven. The patient's daughter said these episodes where her mother was obsessed with helping others were becoming more frequent. The lady sat quietly while her daughter sobbed. “This is insane. I feel so helpless for her,” the daughter said. The patient sat quietly all this time, smiling as if in her own little world. She had an aura of peace and love about her and a sparkle in her eyes. I examined the patient, who asked me several times if I was OK and if she could help me. I smiled back at her. After I was done examining her, I walked out of the room and asked the still-sobbing daughter if she wanted a cup of coffee. I ordered a few basic tests, and returned to the chart rack. The next patient was an intoxicated man, swearing and resisting his restraints, who had been in a motor vehicle crash. This was a patient right up my alley. Several hours passed, and the tracking system showed that we needed to move patients to open up rooms for two ambulances. My confused patient was in an acute bay. The hospital was filled to the brim, and six rooms in the ED were tied up with boarders for the night. My confused patient's labs and tests were good, and there was no indication of any organic cause of her mental changes. I went back to the room, and talked to the daughter. I explained that the test results were good, and that her mother had dementia and was reliving her memories. I told her that her mother needed to be placed in a nursing home and had to stay with someone. I had already talked to the social worker, and she was working her way down to see the patient. I advised the daughter privately that I could place her mom on the psych floor for inability to care for herself and visual hallucinations, and subsequently get her in the nursing home. The daughter wanted to admit her mother to the medical floor, and got hysterical at the idea of a psych admission. She was not ready to deal with the stigma of a psychiatric admission, and pleaded for me to find a safe haven on the medical floor. I told her all hospital beds were filled, and offered the other option of having a home health aide stay with her mother and work with them for placement. The daughter and I went back to the room. The mother had some lucid periods between her conversations, and her daughter told her she had to be admitted to the psych floor or live with someone. The patient responded apologetically, “Oh, no, I want to go home, and I don't want you to worry about me. I will be OK. You have your family to take care of.” She turned to me with an angelic smile. “Thank you, doctor, you were so kind. I am fine, and I promise not to bother my daughter or anyone again.” She continued, “Are you OK, Doctor? You look tired. Can I get you a bowl of warm soup?” She looked at her daughter who was still sobbing, and said, “I am sorry I made you cry. I know you made me a pretty picture from school today, and I forgot to make your favorite treat. I will make it tomorrow when you return from school.” I walked away speechless. The patient left an hour later with her daughter, and the social worker filled me in on their decision to meet with home health the next day. My remaining shift was routine, and I finally left the chaos. But as I drove home, I remembered my confused patient's face, her divine smile, and her loving aura. She had to have been a good person all her life. Even in this hour of her need and memory loss, she remembered to put others' needs before hers. Her memories were as gentle as she was. I felt as if the patient had come to me in the middle of my shift to show me how to steal memorable moments from my life, that I could go beyond my limitations to do more. Her use of the word you more than I left a mark on me. Her need to constantly comfort others could not have started that day. I wonder what I might remember in my hour of dementia. Had I done anything memorable that family, friends, or strangers might remember when I was experiencing dementia? The little moments of life that I live each day are mostly routine. Could I steal a few seconds to make them memorable and special like she did? Her immense sense of caring reflected in a few moments of acquaintance came from a lifetime of giving beyond expectations. I was struck by her aura of kindness, love, and caring. As for the hallucinations, was she crazy or did she really see angels around her? Angels, they say, are always around us, protecting us. I have heard many older patients tell me of people they see around them. I wondered if you had to rise to the level of godliness to see such beings. Who are we to debate the nature of reality? Perhaps there is a world beyond our five senses that can be reached only with a raised awareness of spirituality. My days run into one another, the same-old, same-old hectic pace where I am looking for the next turn around the bend of my life. I began to wonder if this patient was real or imaginary. Perhaps she was an angel who had reached out to teach me the meaning of my life. I felt as if she said I was privileged to receive an assignment to help the vulnerable, feeble, and sick in this lifetime. Indeed, it's a very noble mission. My higher purpose in this chaotic life was to look for every special moment to put you before I and to preserve memories. Some day when I am old, frail, and mostly a burden to my loved ones, I will smile and relive those precious times. I realize I was given numerous opportunities to make memories with my patients, my staff, and my family. I felt an urge to go back to work and hug those around me. I want to say thank you to my patients and my staff for putting up with my idiosyncrasies, and I promise to be a kinder, gentler version of myself tomorrow. I felt convinced of the special message given by the angel who visited me in the middle of my routine day. I will try to remember her message when things appear monotonous in the ED, and I'll make some memories for my demented future!