Our star patient, the hospital celebrity who had apparently managed to exhaust an entire asthma inhaler in one day, came back for a follow up.
She originally came to the hospital because she was in an accident and fractured both her left leg (fibula) and her right forearm (radius). The physician only prescribed her the inhaler because he noticed she had asthma while he was treating her injuries.
She entered the room with her two daughters. I thought people in casts know it is a bad idea to use or put weight on the healing bone--bad assumption. She limped in holding her cane with her right hand, the one in a full cast, walking on the plaster that surrounded her left foot.
Dr. Felix said, "Please sit" and her daughters each put a hand under her armpits to help her into the wooden chair that, when in the room, makes it impossible for four people to stand without touching shoulders.
Out of instinct, I set her cane on the left side of the chair, hoping that would lead her to hold it with her left hand when she got up, supporting the side of her body in need of support--the side of her broken leg.
The doctor looked at her chart, "That's odd...nurse didn't take her blood pressure."
He looked up, "Did you check in with Miss Diga outside?"
"Yes doc," said the wide-eyed sister who interrupted our consultation with a pregnant teenager a few weeks ago.
I looked at the three of them. The 80-year old woman with her soft concentrated expression--the result of a toothless closed mouth--breathing with the focused labor of an asthmatic exhale. The wide-eyed shorter daughter who had not moved her body or gaze from her position directly across from the doctor staring at him with eyeball protrusions. The third member of their party was different from her sister. She was obviously in charge of the situation. Her dominant stance, her sharp eye pokes cycling between me, the doctor, and her mother, her broad shoulders, and the fact that she stood 6 inches taller than her sister told me her role.
Dr. Felix's voice interrupted my analysis, "She didn't take your blood pressure?"
"No doc."
Dr. Felix called out, "Miss Diga, could you please come here?"
He set the chart down on the exam table to wait. The few seconds of pause must have been too slow for the daughter in command because she pulled the curtain open, popped her head out of the room, and said, "Miss Diga. Come here." If someone would have asked me to assign television set volume numbers to their voices at the time, Dr. Felix's would have been at 18 and the daughter's at 32.
After calling the nurse, she guided her sister out of the room, saying "This room is to small for you to stay when the nurse comes in." I laughed into Dr. Felix's eyes.
Looking at the patient, holding her broken arm above her lap with her leg cast stretched out in front of her, I thought about her transportation to the hospital. Most likely, they crowded into a twelve-seat bus with 25 other passengers. I imagined this elderly woman walking on her broken lag, pushing against a cane with her broken arm, leaning on one of her two daughters with the other. She had to walk the block from the bus drop-off to the waiting room. I cringed, 'I really hope she took a bus.'
The nurse wrote the blood pressure numbers down, unvelcroed the cuff, and stepped out.
Dr. Felix asked the older sister who had reentered with her sister before the nurse stepped out "How is the second inhaler working for you?" His eyes twinkled from an internal chuckle.
"Didn't get it," she said.
My eyebrows jumped. I thought I had my fill of surprises from them. "So you haven't had an inhaler for her for several weeks?" He asked.
The shorter sister--to whom Dr. Felix had directed the question said nothing. The larger sister said, "We still have the first one. It's almost gone though."
Dr. Felix asked, "So how many inhalers have you filled prescriptions for?"
"One."
"I prescribed you two. You said the other one was gone."
The older sister raised her index finger, "Yes Doc. I sent her to get another one from you because I knew we would need it once the first one ran out."
"But you never bought it?" I asked.
"And you told me you used all of the first one even though you hadn't?"
The shorter sister smiled--the way you smile when you pull off a successful bluff in a game of poker.
Dr. Felix examined the patient and started writing on a prescription paper. "I'm going to prescribe you some calcium so your bones can repair better. Take one every morning with breakfast."
The two daughters nodded and the dominant one said, "I never bought the second inhaler and I lost the paper for it, so add that to the prescription too."
Dr. Felix looked at me, shrugged and scribbled it down on the paper.
Two refill prescriptions later, this 80-year old woman is still on her first inhaler.
"Before you go," Dr. Felix said, "Tell me how you use the inhaler."
"2-3 pushes whenever she breaths badly" said the smaller daughter, smiling.
Dr. Felix told her, "Hold that with your other arm," as she reached across her chair with her right arm for the cane.
