This is a very old story . But I still remember it as if it occurred yesterday. I was called in for anew consult. As I got the information from my office, I noticed that it was a26 years old patient with diagnosis of the pneumonia, My office takes some information , like name , age , diagnosis, referring physician's name, what is the room no. and how quickly I have to see patient. We also get insurance information. so that if I am not on the insurance plan , we ask some other doctor who is on the plan to see. This also avoids lack of the follow up that may occur due to we being not on the insurance , then asking patient to see other doctor and transfer records etc. So when I looked at the paper from the office I noticed that this 26 years old patient had Medicare , Normally Medicare is only after age 65 years or some one who is disabled for the long time. . So I was sure that this patient was disabled.
When I entered the patent's room , I was shocked . I have seen many miseries, seen gruesome things but what I saw , may be because I was not prepared for it , was shocking. The patient had Hydrocephalus . , Very Very big head. with very small body . His head was more than double the normal size, but the upper and lower extremities were very small. The whole thing was very unusual to say the least, and horrifying at worst.
I reviewed the chart, looked at the x-ray and looked at the old records . Patient was from one of the nursing homes where the most or all the patients are mentally challenged . Many of them develop aspiration, food going wrong way, instead of going in the stomach , it goes in the lungs. So they develop pneumonia. This patient was not any different. I decided to call the mother who was the guardian. I wanted to know about several things , some history, if she would like to consider 'feeding tube ' in the stomach called PEG. to prevent aspiration , and in the future Tracheostomy to handle secretions, I also wanted to know if she wanted to to consider DNR , especially since there was no Quality of life, and the condition was not likely to improve.
The mother was in Chicago. I called her . Someone else answered the phone. The mother came on the phone . I said , 'Hi This is Doctor xxxx . I am a lung specialist and I am taking care of your son xxxx. .I just wanted to talk to you about his care and ask some questions . '
What she said was shocking or may be I did not expect it . She said " Oh doc , for last several years I have been praying God that this chapter would " end " in my life , but, - --. Tell me what can I do for you . "