Sunday, October 17, 2010

Dryer than a Popcorn Fart

My elderly patients crack me up. Sometimes they are whiners, but sometimes they are the funniest things this side of an emergency room.

That title was one of my favorite quotes from one of my favorite patients. This guy got up like every other day of his life, gave his neck a pop, and broke it.

Yes. He broke his own neck.

I’ve known this could happen for years. By known, I mean the grotesque image has run through my mind whenever I see someone crack their neck, and I try to stifle my shudder and use my doctor voice to convince them of something I’m sure of, namely, that they are going to break their own necks right in front of me.

Blech.

Anyway, though I believe I was proven right, I guess I should add something else to the story. He had cancer he didn’t know about, and it had grown metastases in his spine, weakening it. So he still broke his own neck, but his neck did have a few fragile spots.

Unfortunately, the cancer/contrast from the scans that found the cancer also shot his kidneys. The man has been in a halo (he has screws coming out of his skull, yes, through his skin that attach to a halo with a fabric-covered harness down over his shoulders midway to his belly button. He can’t sit up for dialysis in an outpatient clinic, so he can’t go to a nursing home. None of the Long-Term Acute Care facilities (kind hospital-lite) will take him to chemotherapy, so he can’t go to an LTACH. He’s been stuck here for over a month for no reason other than administrative policies. Plus at first they gave him a crappy renal diet, then by the time we figured out to give him whatever he wanted, the chemo had already made him lose his appetite.

You’d figure the guy has every reason to be a grump. But he’s not. He’s always upbeat. He always says, “Oh, I’m doing pretty good!” when you ask him how his day is. Every now and then he says something like, “I need you to blow me out again.” (the first time he said he was constipated, I told him I was going to “blow him out because that was one thing I know how to do well.”).

With the dialysis we realized we might have been pulling a little too much fluid off of him. My attending asked, “Do you feel like you’re thirsty?” to which he replied, “Doc, my mouth’s dryer than a popcorn fart!” I don’t even know what that means, but it was awesome to see my attending try to keep a straight face.

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