It hits like a ton of bricks. The bad news you knew was coming. Please no, not today.

You wish you could have a do-over-go back to bed, wake up, and try again, like in Groundhog Day.

But you can’t…

Or can you?

Meet My Patients

Patient A

A was a sweet teenager seeking evaluation for breast tenderness. Her physical exam was normal, though in her history she shared that she was having unprotected sex.

She was devastated to learn she was pregnant.

Patient B

B was a stoic lady also seeking evaluation for a breast issue-this time a “cellulitis” that had persisted for nine months despite multiple courses of antibiotics. Her physical exam was markedly abnormal with masses, back tenderness, and leg weakness.

Her family was visiting for the holidays and convinced her to come to the Emergency Department for evaluation. They were, of course, also devastated by the diagnosis of metastatic breast cancer. They sobbed and wailed, “Why did this have to happen at Christmas?!”

Patient C

C requested evaluation for a headache he’d had for many years. He had a normal neurological exam and appeared quite comfortable.

When I asked what was different today that led to his ED visit-why he had come today instead of last week or next week-he stated that he was homeless and it had gotten cold outside, so he wanted someplace warm to eat and sleep.

Patient D

D came because he “didn’t feel good” for the past decade. He came today because a neighbor finally made him, but he was adamant that nothing had changed acutely and he wanted to be left alone.

I had to tell him he had end-stage liver disease with ascites and multi-organ failure, likely with metastatic hepatic cancer as well.

To add insult to injury, he was also suffering from alcohol withdrawal because today was the day he finally decided to quit drinking.

Patient E

E’s family dropped her off and quickly left. She was very pleasant and kind, and she was also convinced that it was 1962. She felt great and made fast friends with all the staff for the three days she spent in our ED.

There was nothing emergently medically wrong with her, so she didn’t meet criteria for admission to the hospital. Nevertheless, she couldn’t go home because we couldn’t locate her family and she was too confused to care for herself. Her family had decided that they couldn’t or wouldn’t take care of her anymore.

Not Today

My heart breaks for all of these patients, and I wish there were more I could do to help. I try my best to be patient, kind, and encouraging while also being honest about their options moving forward.

It’s clear that none of these problems began today. They’re not truly ‘emergencies‘ in that sense, though they are definitely life-changing conditions that merit assistance.

For these patients, there’s no point focusing on the past and what could have been done differently.

For us, though, there’s still time.

We can learn from these unfortunate stories and examine our own lives and habits before it’s too late.

Not All ‘Emergencies’ Can Be Prevented

I’m not saying that every accident can be prevented, nor that we should wrap ourselves in bubble wrap before stepping out the door each morning.

Life happens. It’s beautiful, and sometimes it’s messy.

And sometimes it gives you hints about what will happen next.

An Ounce Of Prevention

While more and more research reveals that annual checkups probably aren’t necessary or helpful, seeing your doctor for specific questions or complaints definitely can be.

Together, we can confidentially discuss different options for birth control and safe sex to develop a plan that works with your values and your lifestyle. Teenagers- this is a private visit that we will not discuss with your parents without your approval.

We can review the pros and cons of various cancer screenings vs evaluation only when you have symptoms. If you have concerns, we can arrange for imaging, lab tests, and biopsies, then explain several treatment plans and help you figure out what’s right for you and your family.

Even if you don’t have urgent medical needs, our social workers can help locate resources for shelters, food banks, job training programs, and mental health clinics.

If you’re ready to confront an addiction, we can arrange for detox or rehabilitation programs for substance and alcohol abuse.

When you find that your loved one needs more help than you are capable of giving, we can navigate the maze of elder and dementia care with you to ensure your loved ones are safe and well-cared for.*

If you have other questions or concerns, try us. We might not have the answers, but we can work to find them together.

Unfortunately, ignoring problems rarely eliminates them. Instead, they fester until they explode. We’re happy to help whenever you need us, but the sooner you come the more we can do.

Please don’t procrastinate for months and then make us give you bad news on Christmas. See your doctor now, then visit us next Christmas to celebrate your remission.

 

What will you do today to improve your future health and wellbeing? Please share your recommendations for other community resources.

* In Phoenix, the Area Agency on Aging and the Foundation for Senior Living provide assistance with everything from meals, housing, and transportation to legal advice, job training, home health, and nursing home placement.

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