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.
(*image from pinterest.com)