Diagnostics

How is a 9-week baby like a 90 year-old woman?

It's the start of a bad joke, the kind that medical students tell out of earshot of their patients, and get scolded by their attendings for repeating.

But this question came to me yesterday in the hospital.  We were discussing Ms. Elbridge (not her real name! not her real name! not her real name!), and the resident told me that she seemed uncomfortable.  We went into the room, and sure enough she was writhing like an eel, exhaling deep throaty moans, and twisting the bed sheets around her limbs.

What was causing her discomfort?  Maybe she had an upset stomach.  Or maybe she was developing a pressure ulcer on her lower back from lying in the same position all the time.  Or maybe she had an allergy to one of the detergents used to clean the sheets. We would have to do a detailed physical exam to figure this one out.

Whoa whoa whoa, you say!  Why not just ask the lady what's bothering her?  Yes, that would be a good idea.  But it wasn't going to help us. 

Ms. Elbridge is severely demented.  She looks at me when I speak to her, and she can say her name when asked, but otherwise her replies are nonsensical grunts.

For a patient like this, you often end up making a guess about what's wrong and trying a therapy.  If it works, you assume your guess was right.  If it doesn’t work, you try something else.

As we stood there in the hallway, deciding whether to give her an antifungal cream or an anti-nausea medicine, I had a moment of déjà vu.  But It wasn’t until hours later that I realized why:  We’ve been doing this with Elliot for the past month. 

There are certain flavors to each of Elliot's cries: if it’s mixed with grunts then maybe he’s pushing out a poop.  If he’s hiccupping at the same time, maybe he swallowed a lot of air and he needs to be burped.  If he gets cold, his lower lip trembles like a cartoon baby in a Disney movie about a child locked out in the snow.

Hannah, having spent more time with him, is a better diagnostician than I am.  But sometimes we’re both befuddled, and in these cases--- as with Ms. Elbridge--- we just try something and see if it works.  Throw on a blanket, sing, rub, pat, take off a blanket, flip over, bobble, play a Missy Elliot song.  (No, I’m not kidding, he loves it.  Or maybe it’s just the way Hannah dances to Missy while she holds him.)

Is my point that we are in the end as we were at the beginning?  That we return to whence we started?  That there is--- to quote Elton John--- a circle of life? 

Yeah I guess it is.