1. Anna: You’re making inpatient faculty rounds on a Friday afternoon. With you are three resident physicians and two medical students rotating on the otolaryngology–head and neck surgery service. Just as you finish seeing your patients, you receive a call from the daughter of one of your longtime patients informing you that her mother was admitted to the inpatient hospice unit yesterday and asking if you could stop by for a quick chat. Since you’re just one floor down, you direct the residents and students to follow you to see the patient. Anna is a delightful 84-year-old lady you’ve cared for over a two-year period who has malignant melanoma of the left posterior neck, requiring a wide excision of the melanoma and a unilateral neck dissection. Three months ago, she was found to have widely metastatic disease and has been under the care of the cancer center medical oncology team.
Explore This IssueDecember 2020
As you enter the room, you and your team observe an elderly, gaunt, emaciated woman sitting elevated in her hospital bed. What isn’t usual about her appearance is that she’s wearing a red wig, bright red lipstick and nail polish, and a pink gown with a large red ribbon tied at the neck. As she recognizes you, she breaks into her characteristic cheerful smile, saying, “Oh, doctor, how kind of you to take time away from your busy day to visit.” Behind you, one of the medical students stifles a snicker at her bold appearance.
You approach the bed, and she painfully moves aside and pats the bed for you to sit beside her. “Doctor, you look so very tired,” she says. “Are you working too hard caring for patients to sit a spell with me?”
“Miss Anna, I would never be too tired to visit with you,” you respond. “Is there anything you need that I can get for you?”
“That’s just like you to ask about me when you’re helping so many people. How are you feeling?”
“I’m okay, thanks. Do you have much pain?”
“You’re so kind. I’m fine, really. Nothing to worry you about.” She pauses for a moment. “I’ll remember you for as long as I live.”
“Miss Anna, is it all right if I just stay a while and talk?” you ask. “I don’t want to tire you out.”
“Doctor,” she says, “I have all the time in the world for you. Tell me all about your life and family—I’m a very good listener. Never forget that family is the most important thing in life, and good friends are blessings.”
2. Dennis: You’re staffing the ENT Clinic at the local VA medical center. The junior resident presents the next patient to you after the interview and initial examination. Dennis is an 89-year-old gentleman who has an upper lip lesion that’s been growing over the past four to five years. The resident presents the pertinent aspects of the patient’s history, as well as the head and neck examination findings. When you enter the exam room, you see an elderly, distinguished-appearing gentleman, clean shaven with a neat military haircut, dressed in a clean workman’s shirt and neatly pressed work pants.