E

With Mother. She is sleeping more. Her intake and output is diminishing. She is not in pain or anxious. The aides and nurses from hospice have been wonderful.

I received a call today from E. E worked with me on nights for many years. She retired and enjoys her life. She has had some health concerns and we had a good conversation. She advised me that I should follow my heart and head in deciding how to adapt to the rest of my career.

In the day, there was E and L, an aide and me. Our friend S was our night x-ray tech and our friend D was in the lab. E had trained at the world's best pediatric hospital and her partner L was an experienced critical care nurse. E reminded me that even in those quieter times I could be a PITA. She reminisced how she or L would give me a verbal or physical smack upside my head when necessary.

Two years ago E called to tell me of some disturbing symptoms. She correctly diagnosed her own disease and I arranged for one of my partners to treat her in the ER. An recent alarming visit to an ER where she lives during the winter, was precipitated by chest pains and severe hypertension. She was treated and is doing well.

Last week I cared for two patients with intracerebral hemorrhages (ICH). The first patient was 61 years old. The family found the patient on the floor with evidence of having vomited and unresponsive to voice or touch. The paramedics did a great job of entubating and stabilizing the patient. A CT scan revealed a large ICH that was distorting the normal brain anatomy. I stabilized the patient's blood pressure and transferred her to a tertiary care hospital. The family told us that the patient had been complaining of a headache for a couple of days. The patient had no medical history, but had seen a doctor regularly for check ups. The prognosis is not good.

The second patient was an octagenarian who walked in with symptoms of an episode of confusion and possibly some slurred speech. The patient complained of a worsening headache for a few days. The patient was on coumadin for an irregular heart beat. CT scanning and labs were ordered. The INR was above the therapeutic level and the CT showed a small ICH. There was no evidence of a shift of the normal brain structures. Arrangements were made to transfer the patient to a tertiary care hospital and I started medication to control her blood pressure and gave fresh frozen plasma to reverse her clotting abnormality. The prognosis is good.

My brother-in-law has arrived and we have the golf tournament on the TV. Mother was an avid golfer. Her father and husband were also devoted to the game. She told me that they were disappointed, when I began dating their daughter, because I had no interest in golf. The sounds of the tournament brought a smile to her face.

In the near future I will be enbarking on the next stage of my career. The world's oldest ER doc will become a part timer. Shorter hours, a less busy ER, and fewer or maybe no nights are my goals. I think that with this change I can make it to 40 years in emergency medicine. For now I will enjoy spending time with the extraordinary woman who I am fortunate to have as my mother-in-law.