Breath-taking Sweet Ride

The other day I saw a patient of mine whom I have been following for sometime now in our practice. He is in his early 70’s, but his health is rapidly declining. He has severe COPD and has been on portable oxygen for a couple of years now.

He showed up in our clinic with his new motorized scooter. He said that with his severe shortness of breath and debility, his mobility has suffered enough that he got himself a power wheelchair so he can still move around without running out of breath.

There are hundreds of models of electric scooters and wheelchairs to choose from. There are lighter and more portable models to the heavy-duty but more bulky types. Those heavy ones weigh like a ton but almost impossible to tip over. There are even models that claims they are “sport” version. I don’t know if they have all-terrain model as well. Can you imagine off-roading with a wheelchair?

The price ranges from a few hundred dollars to several thousands of dollars depending on the built and model. Though medical insurance will pay all or part of the cost depending on coverage and eligibility.

Anyway, when I asked my patient how he was liking his new ride, he said that it was definitely useful but he feels it was not “fast” enough.

Most power wheelchairs has a top speed of 5 miles per hour, but there are models that can go as fast as almost 12 miles per hour. Of course there may be unprescribed soup-up version that may go faster, but I’m sure safety will be an issue, unless they equip it with air bags and anti-lock brakes besides the standard seat belt.

Back to my patient, I asked him what kind of car does he drive, since I sensed that he has the need for speed, even though he can hardly move around anymore.

He then told me he drives a Corvette.  But that’s not all.

He also said that he collects Corvettes. He has 4 of them! The oldest one he has is a 1976 Stingray. I guess that explains it much.

He also told me that he used to ride motorcycles when he was still able, and has a couple of Harley Davidson sitting in his garage. I asked him if his wife is jealous of his collection, but he said she has a “sweet” Porsche of her own.

I know his power wheelchair cannot fit in the Corvette or Porsche, so they must have another vehicle that can haul it along. Maybe they have a custom-made rocket-powered monster truck, but I stopped asking.

He though admits he sorely miss taking out his cars for a spin, as nowadays he can barely drive.

It’s just awful to know that he has all these sweet and fast rides, and I’m sure he had lots of fun with them during his heyday, but now he is relegated to his wheelchair and can only go 5 miles per hour. Once life was so fast that it takes his breath away, now life came down to a crawl, and yet his breath is still being taken away so slowly and painfully.

O the sad reality of life.

Life is like a breath. Most of the time we don’t think of it much until the time we’re running out of it. May we value each moment of this life.

As I send him back to the front desk to make a follow-up appointment with me in a few months, after I was done examining him, I told him that maybe he should call Corvette’s headquarters, and perhaps request them to custom fashion a 650-horsepower supercharged wheelchair just for him.

Maybe I should get one for my own. A Corvette, not a wheelchair.  But on second thought, I am not really a Corvette kind of guy.

Maybe a Harley?

 

I’m Free

I was on-call last weekend, and it was busy. The ICU was full. Our patients list was quite long. I only got about 8 hours of sleep from Friday to Sunday, that by the end of my 58 hours shift, I was really exhausted. I felt deflated and defeated.

Days like those, I even wonder, “Why am I doing this?”

After having Monday off, I came to the office the next morning and found this on my table:

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flowers and a memorial service program

The flowers came from a patient, or should I say from his relatives. My patient passed away. I should be the one sending flowers. But in this occasion, it was the dead and the grieving who gave the flowers.

I guess the family was just grateful and appreciative of the care I gave their loved one. Even if the end result was death.

Day like this, reaffirms why I am doing this.

I have taken care of this patient for almost 10 years. And over the years I saw his constant struggle to breathe, and his progressive decline. By the past year or so I have been seeing him so often in the clinic or in the hospital, that I have come to know him very well. Yet, despite our efforts he continued to get worse.

At the end I knew I have nothing left to offer him, and so we have agreed to place him under hospice care.

He had Chronic Obstructive Pulmonary Disease or COPD.

Damn cigarettes! If there’s any young people here reading this article and are smoking and feels that you’re indestructible, I am pleading to you, please stop smoking. I am a constant witness of the destructive effects of cigarettes and the utter suffering they cause. Whatever pleasure smoking gives, it is not worth it.

Though I would admit, some of the nicest people I came to know were smokers. And that includes my patient. They are just slaves of a bad habit that may not be their own doing.

In the funeral program of my patient that they also sent to me, was a poem by Ann Davidson, printed on it. A poem so apt for my patient. It was entitled “I’m Free.”

Free from the pain. Free from suffering. Free from the disease that tormented him. He was indeed free.

I’m Free

Don’t grieve for me, for now I’m free

I’m following the path God laid for me.

I took His hand when I heard Him call

I turned my back and left it all.

I could not stay another day

To laugh, to love, to work or play.

Tasks left undone must stay that way.

I’ve found that peace at the close of the day.

If my parting has left a void

Then fill it with remembered joy.

A friendship shared, a laugh, a kiss,

Ah, yes, these things I too will miss.

Be not burdened with times of sorrow

I wish you the sunshine of tomorrow,

My life’s been full, I’ve savored much

Good friends, good times, my loved one’s touch.

Perhaps my time seemed all too brief

Don’t lengthen it now with undue grief.

Lift up your heart and share with me.

God wanted me now; He set me free!

Life’s Worries

A couple of weeks ago, I took care of a patient who was admitted in the hospital for shortness of breath. She has COPD (CDOP if you’re obsessive-compulsive), a disease due to smoking, and went into acute respiratory failure.

The patient was really struggling to breathe thus the Emergency Room doctor placed her on a non-invasive positive pressure ventilator (NIPPV), a device similar to CPAP used by people with sleep apnea, to provide assistance in her respiration. She was then transferred to our ICU.

On the first day that I rounded on her she was still on the NIPPV and unable to talk much, as it was almost impossible to talk with that mask on, for it’s like having a blower in your face. I would not be able to hear her clearly anyway even if she wants to speak. Though I examined her thoroughly, I limited my history-taking to questions she can answer by yes or no.

The next day she was much better and we have weaned her off the NIPPV. She was sitting in a chair, breathing much easier and looking comfortable.

I pulled up a chair and sat beside her and talked. She admits she has been diagnosed with COPD for years, and has even been on oxygen at home. But sadly to say she continues to smoke. Damn cigarettes! I guess old habit never die.

I told her that it was vital that she quit smoking. Yet in the back of my mind, she has done quite good despite of her bad habits, for she was 84 years old after all, and she still lives independently, all by herself.

Then when I asked her how can I help her quit smoking, she relayed to me that she smoke because she was stressed out.

What? She was eighty-four years old and still stressed out? She should be relaxing and enjoying life, or whatever is left of it, at this age.

That was when she told me that she has not gotten over the death of her husband, whom she was married for sixty-one years. He died three years ago. I suppose the heartbreak never heals when you lose somebody you love and lived with, for that long.

If we only peel off our prejudgment and peer behind the puff of cigarette smoke, we will learn that these people are hurting inside.

Then she said that she was also worried about somebody she knew longer than her husband. She was worried about her mother.

Her mother? What?!!!

Wait a minute, was my patient confused? Too much medications maybe? Was she having ICU delirium? Or does she have the beginning of dementia perhaps?

But as I talked to her more, I ascertained that she was very lucid and of clear mind. She was indeed worried and stressed out about her mother, who has been in and out of the hospital for the past several months.

Her mother was 103 years old!

I came out of the ICU room with a smile. I was ever so determined to help my patient get well. And maybe if I can get her to relax and convince her to quit smoking, she will live more than 103.

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view from the hospital’s corridor

(photo taken with an iPhone)

Shivering Tulips

Arctic blast is back in our area. After a few days of relatively warm days with some melting in our piles of snow, our temperature is again in single digits (Fahrenheit). The next few days does not look encouraging either. Afterall, we are still in the thick of winter.

As I was seeing patients in our clinic today, one of the constant small talk that I have with my patients is the cold weather. With most of my patients having significant pulmonary condition, this subfreezing temperature is such a struggle for them. My parting shot with them as they get out the door is “stay warm!”

The last patient I had this morning was someone who had been followed in our clinic for more than ten years. Ten years is more of a rarity to be followed by us, as most of them are with advanced lung disease and thus they do not last that long.

He is an old sweet man with a sunny disposition, but crippled with severe COPD, and had been oxygen-dependent for several years now. Damn cigarettes!

He is on maximum medications, inhalers and nebulizers we can place him on, but despite of that, he admits that minimal exertion, or even talking, makes him short of breath. Though he said that not talking much is probably good for him, as his wife who always accompanies him on his visits, laughed with his confession.

As we talked about the deep freeze, he stated that it was too cold outside that the “tulips were shivering.” I told him that it was not yet spring, and so it was not time for the tulips to get out anyway.

When I asked him how he was doing, he said that he was “ready to be planted.”

Was he still talking about the tulips? Or did he mean being “planted 6 feet under ground?”

I know he understands that we have not much to offer him, yet he always come to his appointments, even just to chat with me and my nursing staff. Sometimes I feel that a plain doctor visit gives some of our patients a chance to get off their mundane schedule and provide something to take their mind off their existential misery temporarily. And by merely showing up in our clinic, they let us know that they are still alive.

Don’t get me wrong, I am happy to see them. I know as well, that they are happy to be seen. Or perhaps they are happy just to be here.

Knowing that his condition will only get worse, our discussions wandered to what his advance directives might be. He said that if it comes to a point that he cannot breathe on his own, he does not want to be placed on a ventilator or a machine to keep him alive; and if his heart stops, he said that he does not want to be resuscitated. In other words, he just want to go gently and naturally into the night.

I even offered that I can refer him to Palliative Care Medicine or even Hospice, but he said that he was satisfied with my management and did not feel we need to do anything else at this time.

As I walked out of the exam room, I called out to him, “stay warm!”

He looked at me meaningfully, as if he expects something more.

Quickly realizing my comment, I said that I wanted him to “stay warm” from this arctic temperature. To “stay warm,” that is to keep his sweet and positive disposition. And to “stay warm,” that means staying alive and warm-blooded, and being above ground.

With that I added “I’ll see you in spring.”  I hope the tulips will not be shivering. Nor weeping.

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(*image from pinterest.com)

 

Behind the Puff of Smoke

Marion was sitting in the examining table. He looked cachectic and debilitated. He was stooping forward, leaning on his arms like a tripod. His lips were pursed as he breath, and was using his neck muscles to assist his respiration. A small tank of oxygen was at the foot of the table and it was connected to a long tube and into a nasal cannula that was hooked to his nostrils. He was obviously struggling, but he managed to flash a smile when I entered the room.

I have known Marion for more than 5 years, and he went through a lot over the years. I have treated him for severe COPD (Chronic Obstructive Pulmonary Disease) and repeated exacerbation, lung mass, bouts of pneumonia, respiratory failure requiring mechanical ventilation, lung collapse requiring chest tubes, and multiple hospitalizations. He had gone weaker and weaker, and is wasting away with every labored breath. It is painful just to see him breathe. He was a heavy smoker, but had quit a few years ago, albeit a little too late. He is paying for all the years he had puffed away with those damning cigarettes.

I hate cigarettes! No, I have no personal vendetta against the tobacco companies. In fact, if there is a career that cigarettes made to flourish, it is mine. I partly owe my profession to cigarettes. Because of so many people who smoke, I have a lot of pulmonary patients, and that I can send my kids to college. And even if smoking will be banned starting today, we will still see the effects of smoking for many more years to come, that my practice will be secure until I retire. But I am witness to the tragic effects of smoking every single day, that it is plainly heartbreaking. I just wish people will stop smoking. Besides, there will be other lung patients aside from smokers, that I can survive with.

It is amazing that even with the known cold hard facts regarding the ill effects of tobacco, people still continue to smoke. And more astounding is the fact, that young people who are well-informed, still start and pick up the habit of smoking. I know it is hard to quit once you have formed the habit, but still it is difficult for me to fully understand why people would continue to smoke even if they are literally dying from it.

Many years ago,during my training in Memorial Sloan-Kettering Cancer Center, I have seen patients who have lost their voice box due to throat cancer, still smoking thru their tracheostomy tube, in front of the hospital, while they lean on their IV poles. I have even seen patients who had caught ablaze and suffered facial burns, as they tried to smoke with their oxygen on. I guess they wanted to go out blazing into the night.

Nowadays most of the hospitals have adopted a smoke-free campus. Nobody can smoke in the hospital grounds, so smokers have to get out of campus to lit-up. Here in Iowa, there is a state-wide ban in smoking in all public places, like restaurants and malls. The only public place that smoking is still allowed here, are in the casinos, but that may change soon too. For some reason smoking and gambling goes together. If you think about it, smoking is really gambling, with your own life at stake.

I strongly advise all my patients to quit smoking. We even provide support, counseling and prescription to help them quit. But still quite a number of them still do smoke and this get me really frustrated. Are they just a bunch of non-compliant morons?

Before I pass that judgement, I should distinguish my aversion between smoking and smokers. I should definitely abhor smoking, but not necessarily smokers. For it is ironic, that many of the good and kind people I come to know, are smokers. Behind that annoying puffs of cigarette smoke, is a person like you and me. A person who may be suffering, a person who needs help, and a person who needs love and understanding in spite of who they are.

After I examined Marion, he told me that I need to keep him going until June. I asked him what’s going on in June. “It will be my 50th wedding anniversary”, as he answered with a smile, “and I would not like to miss it for all the world.” I felt a lump in my throat. I know he is on borrowed time. But I prayed that his wish would be granted.

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Post Note (4/14/12): Marion made it through his 50th wedding anniversary. He passed away a year after this article was posted.