She was a disheveled, frumpy little thing, with wild eyes and stringy white hair. Slumped on her bed, she was labeled as a psychiatric consult patient, which generally means she was medically low maintenance/priority for our staff unless she causes a disturbance. However, because her advanced age, the doctors decided to make sure she had no underlying medical problems. And of course, I was asked to draw blood from her with the distinct undertone that she would probably refuse.
She stared at my face as I approached, bloodshot eyes suspicious, lip snarled. "Well what do you want now?"
"Hi, I am S, a technician working in this area. The doctor would like me to draw some blood work...'
"He doesn't know what he's doing. I'm fine."
I usually like to hear "no" three times before I stop trying, so I tried again.
"Well, he just wants to make sure you're OK since you are in the ER, you know... I see you've brought your veins here with you today and I will be very quick with the needle."
"These young doctors keep ordering all these unnecessary tests. Look at me, I'm fine. I don't even know why I'm here."
"Well, you had said you want to hurt yourself to somebody and they called the ambulance. How do you know they're unnecessary, ma'am?"
"Where is this place? Am I at ____? (I nodded) I was trained here, you know. I worked here for decades. What do they know?"
I eyed her in a new light; the looks, smart little shoes, haughty dismissals made sense now.
"I guess I ought to call you doctor!"
"Yeah, well, I'm retired many years," she replied, slightly mollified. Then, as if she suspected me, she added defiantly, "and if I wanted to hurt myself, there is nothing you or anyone could do about it."
"I wouldn't say that... that will make you stay even longer. But if you let me draw blood and we have evidence you have nothing going on, then the psychiatrist will see you faster and you could potentially go home sooner."
She considered this. "Fine." She gave me her arm and refused to look at me.
My patient had threatened to put a violent end to her life by taking a metal statue and thrusting a part of it into a light socket. Alarmed, her facility called an ambulance and she was transported to us. Looking at her 80+ year old frame in mismatched sweats, one would never guess she was once a pioneer of medicine. I stayed with her and slowly, I gathered the pieces of her story. One of the first female physicians, she underwent unbelievable hardships and prejudice what was once the gentleman's exclusive club of medicine. She told me haughtily that back in the day, there was little distinction between the fields. Your primary care physician could also be your surgeon who could also do your autopsy. She scoffed at 80 hour residency work weeks, stating that the residents today miss out on so much, which is why they don't know how to put their hands on a patient anymore. She decried her treatment in her facility, then mused the potential benefits of new technology. Fired up about her passion, she burst temporarily from her depressed cocoon of stained sweatshirts and dementia, and suddenly I caught a vision of the timelessly beautiful and viciously ambitious young physician she was.
Then, she remembered her current state and fell silent. The sharp-eyed girl became again an old woman. I felt the sinking feeling of an elevator descending too fast. What it is like to be at the top of the world, then falling slowly, piece-by-piece, day-by-day, year-by-year into the abyss of dementia, I shudder to think. Soon, mercifully, the helping hand of dementia and sundown-ing helped her out of her gloom and returned her to the daily distraction of confusion.
S
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