ER Longitudinal Care

Yes, that’s an oxymoron, but it happens, and it happened to me tonight.

One of the many reasons I’ve always liked Emergency Medicine is that there’s no seeing the same patient over and over again.  Some doctors live for that, but not me.  I hated my Internship, and partly because of seeing the same patients with the same problems day after day.  I had the same patient on day one and day 365 of my internship, and month upon month on different rotations, and watching that poor person die in stages still haunts me.  Heartbreaking, really.

However, reality is that in any ED there’s going to be some small number of patients that are seen frequently enough we get to know them, and they’re not ‘our patients’, but they’re sill patients we know, and some we take interests in, for whatever reason.  Sometimes it’s the ‘how are they still alive’ wonder, and sometimes it’s because we’ve made a life-changing diagnosis.  Like the patient I saw again today.

I saw this couple one year ago: they were very nice, and the husband had unmistakable signs of a brain tumor.  I remember them because of the history obtained on that first encounter: He’d been having symptoms for a month or two, but they’d had this trip planned for months, so they’d gone on their lifelong dream vacation to Alaska, and had a great time.  They drove straight to the hospital from the airport after getting home.

I was the physician who got to tell them about the walnut-sized mass in the brain responsible for the symptoms.  I explained tumor and edema to a silenced couple that expected bad news but not that bad.  They were polite, and hopeful that the future would bring a cure.  They weren’t alone in that regard.

I’m also the EM doc who’s seen them several times for the unending complications of the therapies: the seizure, the antiseizure medication toxicity, the post-op infection (fortunately not of the brain), etc.  Today I was leaving the ED and saw him: face swollen from steroids, listless, spouse at the bedside still looking hopeful.  Spouse recognized me instantly, but my former patient didn’t react to my presence.

“Hello, I just saw you and hope you’re being treated well.  I’m not sure why you’re here…” and the blank look in his eyes stopped me dead.  Either there was no recognition or it’s that “I want you dead’ look, and frankly it was a tossup.

‘Yes, we remember you’ said the wife, and pleasantries were exchanged.  I cannot imagine the things they’ve been through, the life changes endured, the sacrifices, the heartbreaking setbacks.  ‘I remember you’ said the husband, not meaning it.  He didn’t know me from Adam.  That’s okay, it’s not about me, at all, it’s about a loving couple, and their life together. 

Hope they remember their vacation, forever.