This Old Goat meets This Old House

So this week, one of my patients wanted to share some of his clonazepam with his goat. Seems that the goat has been helping himself to the siding on his house. The guy comes in with his wife, who keeps referring to "the old goat" that is eating them out of house and home. I'm thinkin' she's referring to her husband. Takes me a few minutes to figure out that they're talking about a real goat; which explains why the old goat keeps talking about himself in the third person. :-) So now that we have that figured out, I say no. I don't treat old goats. Well, I do, but old goats in the figurative sense. But I digress. This old goat wants a benzo for his old goat. I ask him, in all seriousness, why he is asking me for a benzo for his goat? And you know the answer already: "But the vet charges an awful lot, and my co-pay with you is free." Yup, you knew already.

A while back, I had a woman who brought her husband into the geropsych clinic to "check him out and make sure he was ok." She refused to divulge any more information than that. When I asked her if he'd been given any medication, she got a very peculiar look on his face, stammered a bit, and then confessed. Seems she had taken her husband, who had Alzheimer's, on a trip to see his family. He apparently developed a mild delirium, and started acting out when they were trying to change planes. There they were, two frail elders, one with dementia and a mild delirium, the other in a state of sheer panic, stuck in a strange city, with flight attendants threatening to not let them board the plane until he calmed down. "I was afraid he would hit someone, and they would put him in jail. So I did the only thing I could think of. I dug in my purse, and I got those pills that we give our golden retriever when we have to take him to the vet, and I gave him a couple, and he calmed down and slept all the way home."

So there you have it. The real difference between psychiatry and veterinarian science? Medicare reimbursement is better for the vet.

Gretchen

Agoraphobia

My poor, pitiful, neglected blog..... I'll try to do better.


So last week I met The World's Most Compliant Patient (TWMCP). She just celebrated the big One-Oh-Oh and became a centurion. Centurian? Centurygenerian? Oh, let's just call her TWMCP and be done with it. Not that she became TWMCP by reaching age 100, but I'm ahead of the story.

The story begins in 1909, which is how all of my geriatrics patients tend to start the CC: "Well, Doc, yousee back in 'ought-nine..." Anyway, she tells me that she was a "sickly child". Back in Ought-Nine, sickly children didn't do well. Her parents sent for the doctor, and he apparently told them "She is a sickly child, don't let her sit in a draft." So she didn't. In fact, she stayed bundled up and out of drafts until she turned 17, when she married her husband without even leaving the house. They lived in the very house in which she had been born, where she continued to stay out of drafts until the birth of her first child.

She dared not venture out of the house after childbirth, after all, she didn't want to risk a draft turning her firstborn into a sickly child, so she bundled up the both of them and they stayed out of drafts until the next child came along. By the time she turned 30, she had turned out some six children, all of them bundled up and steering well clear of drafts.

Around the summer of 1940 or so, her sister arrived on her doorstep, demanding that she go outside for a walk. She had not left the house in 30 years. So she bundled up, and went for a walk with her sister. "And don'tcha know, there was a bitter wind! Well, I told Sis to take me home, but she was stubborn as a mule! Well, I called for Dr. Johnson, he knew me, you see, and I told him that I wasn't feeling well, and he said, 'well, try to stay out of a draft.' So I did."

And she did. She stayed bundled up in her house for the next 60 years. She celebrated her 100th birthday, right where she wanted to be, in the same house that she was born in Ought-Nine. She left the house on exactly 3 occasions: her venture out with her sister, her husband's funeral in the late 1990's, and her recent trip to the hospital with a pneumonia, that she insists was due to sitting in a draft.

I asked her how she managed, all these years. I expected something profound; something Emily Dickinsonish, something deep and meaningful after having lived The Solitary and Examined Life. I leaned in close, and she winked at me and whispered...... "QVC!"


Gretchen

We Band of Wounded; We Band of Healers

"All of us who attempt to heal the wounds of others will ourselves be wounded; it is, after all, inherent in the relationship."

David Hilfiker, MD

Ok, here we go.
Never done a blog before, and not sure what to expect. But over the past month I've heard the sobering tales of three wonderful colleagues that lost their enthusiasm for care of vulnerable elders. Two could no longer afford to keep their practices open with the pittance that Medicare pays. One simply got tired of the mountains of paperwork that precluded her from being able to actually see patients.

The care of the vulnerable elderly is fraught with problems. Everyone agrees that it's important, but no one want to pay for it. Long hours, little reimbursement, but we do it because it feeds our souls.

Until it doesn't.

Until things happen that suck out your soul. You are given productivity benchmarks that are set up for care of the young and healthy. Your unit is staffed with less nurses, because your patients are "nursing home patients anyway". You get depressed. You lose your confidence. You wonder if it's worth it. Your favorite patient dies. And then another.

Sad stuff out there. Life is tenuous; take your joy where you can.


Gretchen