Tag Archives: Aging

“Geriatrics Saved His Life!” A True Story of Geriatric Heroism

“What are we going to do with him?”

Dale scope 2

I couldn’t help overhearing the oncologist talking to his team across the small space in our provider’s work room. An unusual work room, not because of what it looks like, but because of who’s in it. I am a geriatrician, and I work directly alongside my oncology colleagues in this room. I’m “embedded” in the oncology clinic, a bit like a medic among the soldiers in a war zone. They are constantly “fighting” the War Against Cancer—and I am always caring for the patients who are damaged in the fight. They are “saving lives” and I’m “saving” the quality of those lives—often even helping bring those lives to an appropriate close. I had created this clinic just for this reason.

My colleague went on …

“I don’t know. He needs treatment … his prostate cancer is metastatic … he’s losing a lot of weight … but he’s homeless. How do we treat a homeless guy? In the middle of a Chicago winter? On a Friday? Even if we admit him to the hospital for a ‘social admit,’ what are they going to do with him on a weekend? And then, he’ll be back out on the street, anyway.”

I listened while pretending not to. I have learned not to jump into the fray when oncology is wrestling with a problem. To avoid the “what do you want” look, complete with the eye-rolling. I kept listening, but without even looking.

“It’s a crazy story! He is an educated guy, married, recently retired, and then he got cancer. While he was trying to figure out what to do, his wife took most of his savings and left. He was hospitalized, placed in an assisted living facility afterwards for rehab, but hated it and left. Then he was in a shelter, and he left that because of the food. Now he’s homeless, with no money, and he’s got metastatic cancer. And his other family members don’t help out.”

“So what do we do?” asked the physician assistant. Long pause—nobody had an answer. “Why don’t we ask Dr. Dale? I think the patient’s kinda old—maybe geri can help.”

An opening. An opportunity.

“Is there something I can help with?” I asked.

Although I knew the story already, I patiently listened to it again.

Then, despite my hopelessly full clinic schedule, I went to see Mr. Lessman (not his real name). A thin, bony African American man sat there, with a bushy afro-style cut, shading from dark at the skull to white at the tips. He was disheveled, his clothes were torn and dirty, and his dentition was terrible. He smelled awful, as one would expect from a man with metastatic cancer living on the streets of Chicago’s South Side in the middle of the winter.

But he spoke carefully, articulately and precisely—no evidence of cognitive impairment. In fact, he talked exactly like my university colleagues; which was appropriate for a man with advanced education. And he took careful notes in a spiral binder he carried, asking me for clarification for the pronunciation and spelling of all the medical terms. I felt a bit like a student in a seminar.

I went back out to see my oncology colleague in the work room, and I told him I thought we could help. I was met with a wry, skeptical shrug.

But I knew something he didn’t: I had Erica on my side, who I was sure could help us. Because she’s a geriatrics hero.

———————–

I met Erica Riley when I decided to work at our inner city long-term care facility. She worked there, as a nurse, serving as the university liaison for our patients discharged from the hospital onto one of the floors. During my fellowship training in geriatrics, I found working in nursing homes bureaucratic, intimidating, and frustrating—and I vowed at graduation not to do it again. But when the faculty member serving as the medical director of this facility left precipitously, largely in response to being unable to effectively change the facility’s care quality, there was nobody else to step in. So, even though I was a researcher and the section chief, I decided to jump in myself.

Temporarily, I thought.

This particular nursing home is located in the middle of one of the poorer neighborhoods on Chicago’s South Side. Like many such facilities, it struggles financially, trying to survive on a combination of patients covered by Medicare, Medicaid, or no insurance at all. Most of the patients here don’t have other choices, and, like the people living in the neighborhood, almost all of the patients are African American. It is the kind of facility health policy experts like me write about—in the abstract—all the time, and usually in a vaguely negative way. Like many such experts, I had actually never worked in such a facility. And, I was sure, the people who worked there would recognize this right away. Erica Riley, LPN, certainly did.

When one meets Erica, one is immediately struck by her intensity. At the time I met her, she had been at the facility for two years. I have rarely met someone who is as committed to the care of older adults as Erica. She worked for five years in a surgical unit—but she loved working with older adults so much that she quit that comfortable job to work in long-term care.

She once told me, “I always desired to take care of geriatric patients. It reminds me of taking care of my mom when I was young and she was sick.” She was recruited to this particular facility specifically to run the University Program we were building, brought on board by an administrator who knew how dedicated and hard-working she was.

Erica is one of the most genuine healers I’ve seen; she has remarkable instincts for knowing just what a patient needs. She describes her own motivations this way: “Helping someone to get stronger mentally, physically, and emotionally when they can’t help themselves” is what drives her. “In school, we were taught not to get emotionally attached to patients, but for me that’s hard to do,” she says. “When I take care of patients, I feel like they are my family. Being there to listen, nurture, and provide excellent care means the world to patients—just to have someone that genuinely cares.”

Caring for the patients at our facility, one is constantly struck by how many of them count on, believe in, and trust “Miss Erica” to make sure they get the best care.

She also reflexively embodies the ethos of team care. She describes how much she enjoys working with our university team this way: “Coming together to provide consistency and continuity of care is great. Knowing that we can work together to provide exceptional care means everything to me. My being able to change the lives of our patients means a lot.”

The only way a nursing facility can maintain a constant culture of caring is through its nursing staff. Erica is the spiritual center for the facility; she ties the patients to the physicians and the rest of the care team, making it possible for us to provide excellent care in difficult circumstances.

As I said, I had a “secret weapon” for our fight against cancer. Erica, a geriatric hero.

—————-

Back in clinic, I told my oncology colleague, “Don’t worry. Let’s get Mr. Lessman admitted to our long-term facility. We’ll get his situation stabilized, straighten out his medications, get him eating, and then have him come back to clinic in a few weeks. Then you can decide if he can be offered treatment for his cancer.”

“Don’t we have to admit him to the hospital first? Isn’t that the rule?”

“Not necessarily. I’ll talk with the administration. I think it’s better to get him into the facility and get this started immediately. A weekend in the hospital won’t be as helpful.”

“Can he get some IV fluids there?”

“Sure.”

I texted Erica on my phone, told her about Mr. Lessman, and explained what I had in mind. “What do you think?” I asked.

“Of course! No problem.” No hesitation. “Give me a few minutes.”

Sure enough, within the next 30 minutes, an admission was arranged. I turned to my oncology colleagues and told them what was happening. They were impressed, bordering on amazed. They hadn’t seen anything quite like it. I could tell they were skeptical about what could actually be done. But I knew I had Erica on my side.

————-

Our multidisciplinary team in the nursing home met for rounds the following Monday. It’s led by Erica. For appearances, the team pretends I run the meeting, but everyone knows Erica really does.

“How’s Mr. Lessman?” I asked.

“He’s OK,” Erica reassured me. “Except for one thing. He won’t eat anything.”

“Why? Is he nauseated? Or does he have abdominal pain? Or constipation? What’s the matter?”

“No, none of that. He just doesn’t like any of the food. He’s very…” Erica had a funny grin on her face. “… particular.”

I frowned. “What does that mean?”

“He only wants grilled cheese sandwiches. No butter. White bread only. Nothing else. For every meal. And I’m being told we can’t do that here.”

“Let me talk with him. Then let’s talk with the kitchen and administration.” I talked to Mr. Lessman; the nutritionist talked with the kitchen; Erica talked with administration. As usual, Erica was exactly right, mostly because she had worked much of the weekend, although she wasn’t scheduled to do so. Without giving lots of details, Erica let us know that Mr. Lessman had quite a few of these personality quirks. And he had a long story to tell about his personal situation. He also had a notebook full of questions. And all of it fit together, in the way individual lives do, full of personal nuance, touched with tragedy, and played out over a lifetime to reach this point. A full life, lived fully. Learning about such lives is one of the joys of geriatrics. It’s also essential to helping patients improve.

As Erica tells it, Mr. Lessman “is one of the patients that’s dear to my heart. His appetite is extremely poor due to his diagnosis, but by sitting by his side, communicating with him, and encouraging him not to give up, it has made a tremendous change. The smallest acts of kindness can mean so much. … He has now started to consume more food, his appetite has increased, and he has gained weight. He has become a lot stronger.”

Which he has. We give him grilled cheese sandwiches all day long. He takes meticulous notes in his notebook, and he asks me questions each week. We have helped him straighten out his finances, and he has decided to stay at the facility long-term. We provide him transportation to his oncology appointments. And Erica makes sure everything is taken care of.

——————–

A few weeks later, Mr. Lessman returned to our Friday clinic is see the oncologist. I heard about it from my colleague, who came into the workroom, laughing and carrying on.

“Hey, Mr. Lessman is back. He looks fantastic! We’re going to treat him!”

“Great!” I said. “I thought he was a goner. You did a great job with him.”

“Not really me. The people in the facility are responsible, especially our nurse, Erica.”

“You know what?” My oncology colleague was laughing.

“What?” “Geriatrics saved his life!” More who-would-have-believed-it laughter.

I never thought I’d hear that phrase, especially coming from the mouth of an oncologist.

————————-

I’ll give Erica the final word: “This warms my heart; this is what nursing is about. Healing the sick and making the weak stronger physically, emotionally, mentally, and spiritually. This is what our program’s about. To have such dedicated physicians to care for our patients is unknown in our community. Our patients deserve better, and this program is a great start.”

This essay won the John A Hartford Foundation‘s “Heroes in Geriatric Care” essay contest in 2013. 

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Filed under Aging, Chicago, Geriatric Oncology, Geriatrics, Heroism

Visiting Joshua Chamberlain’s House (Part 2)

(Part 1 can be seen here).

A Remarkable Life

By any measure and for any time, General Joshua Chamberlain lived a remarkable, dramatic life of adventure – especially for a professor of religion.  Most famously, he was the colonel leading the 20th Maine Volunteer Company in the Civil War who defended the far left flank of the entire northern Army of the Potomac on Little Round Top at Gettysburg. With a left-wheel, bayonet charge down the rocky hillside, they are credited with saving the army, and perhaps the war, on that July 2nd day.  He endured one of the six serious wounds he ultimately received in the course of the war, leaving him in constant pain for most of his long adult life.  One of those wounds was a .50 caliber minie-ball through two pelvic bones, which nicked his bladder, and was universally considered fatal.  When General U.S.Grant heard about the grievous wound, he had Chamberlain promoted to General on the spot in the field, in order for him die as a general. From the hospital, Chamberlain wrote a lovely “last letter” to his wife as he lay awaiting death.  Against the odds, he recovered and rejoined the war effort, despite a significant limp and severe difficulty in riding his horse.  He continued to lead his regimen so well, as fate would have it, he led them to trap General Lee and the Army of Northern Virginia as they retreated from Petersburg to Appomattox Court House.  The Fighting Professor was then asked by General US Grant to be the regimen to receive the official surrender of Lee’s army.  At the crucial moment of the surrender, as Lee’s army approached to lay down their swords, heads’ bowed in grim defeat, Chamberlain ordered his men to “present arms”, a gesture of honor and respect to a worthy opponent.  It memorably altered the moment’s tenor, converting it from a conquest of a hated enemy to a hat tip to a future colleague, and becoming a symbolic offer of “charity towards all” harkening back to Lincoln’s Second Inaugural Address. Chamberlain had a kind of “perfect pitch” for history’s pregnant moments.

Following the war, Chamberlain returned to Maine, serving four terms as Governor, followed by a lengthy stint at President of his alma mater, Bowdoin.  Much of this time he spent writing his memoirs, particularly of his exploits in the Civil War, mostly from within the house on Potter Street, just off the Bowdoin campus.  This is where the Chamberlain Museum is now located.  We turned in.

A Remarkable House

We arrived just in time to sign up for a tour of the facility, which overlooks the Bowdoin campus.  The tour is enthusiastically led by a loquacious volunteer, an 80-something docent – my absolute favorite kind of historical guide.  The WWII vet, so reminiscent of the men I cared for during my clinic during residency at the University of Pittsburgh VA hospital, is full of facts, opinions, and a gleaming eye for the kids on the tour. As he limps through the house, holding on for support, he offers an authoritative opinion on anything and constantly asking, “What other questions do you have?”

The lovely old mansion is somewhere between dilapidated and magnificent, with cracked walls competing with restored, original furniture.  The on-going, underfunded restoration effort is battling with an on-going process of weathered decay, with the final outcome standing in the balance, a distant echo of Little Round Top itself.  The lady up-front tells me they just received a small private grant to restore the chimney, but need about 50 times that much to complete the full restoration. Two of the rooms have significant recent water damage, making one of them, the kitchen, off-limits for the tour.

The house itself has an unusual history.  Built originally in early 1800s, the original structure was later moved en masse and pivoted, rotated from facing Maine Street to facing Potter Street and the Bowdoin campus.  Later, when Chamberlain became college president, his wife refused to move into the official president’s house a short distance away.  In order to maintain the desired living quarters while adding an area to conduct official business, the entire structure was then jacked up 11 feet, and a new ground floor was added, a predecessor of Chicago’s later raising of its downtown buildings from the sinking muck they were built upon.

A Remarkable Collection

In the first room, the docent asks the kids, what U.S. President with the initials J.Q.A. was in office at the time of Chamberlain’s birth.  To my delight, my 11 year old nails it – John Quincy Adams.  I’m especially tickled because the kids rarely pay attention at these history tours I inflict upon them, but because I’m reading a biography of John Adams right now.  Which leads to another of those “can-you-believe-it?” facts of history – Chamberlain’s wife “Franny” is related, in a tangential way, to the Adams family.  She was born to a relative by marriage of John Quincy’s, then adopted by another, childless member of the family.  A tenuous tie between the Revolutionary Generation and the Civil War generation – I absolutely delight in such connections.  The docent is equally delighted that one of the kids got the answer to his question, and we’re off and running.

The displays within the house mirror the contrasting quality of the overall building. The displays are not the polished work of, say, the Lincoln Museum in Springfield; rather, they are competent descriptions of the items. They are arranged loosely by themes in specific rooms, but they are not thematically arranged or organized into a narrative.  Our guide points to items that strike his fancy, but completely overlooks some others.  But what a selection of items!  There is a room that contains his actual Medal of Honor – the most prestigious medal given by the military, one that Truman reportedly said he’d have given up the presidency to receive.  It hangs, unprotected, on a wall and receives a short mention by the docent.  In a case, there is a bullet fragment – that was removed from Chamberlain!  The docent doesn’t mention it, but when I ask, he says it’s from the foot wound he received at Gettysburg while fighting on Little Round Top!  We linger over portrait paintings of his parents, while the original Tojani oil painting of the bayonet charge on Little Round Top goes undiscussed.  I have to confirm the authenticity of the painting as we move out of the room.  The house is simply full of amazing artifacts, openly displayed for inspection, and the docent offers great anecdotes.  But one is best served with a prior knowledge of the relevant history in order to fully appreciate the value of many items.

As we meander through the house, we learn more and more quirky facts. The odd-shaped rooms with rounded walls and no corners was designed by the ship-builder, not an architect.  Among those who sat on the furniture in the dining room are U.S. Grant and Harriet Beecher Stowe, author of Uncle Tom’s Cabin; Ms. Stowe’s father taught as Bowdoin.  Speaking of Bowdoin, Chamberlain had Henry Wadsworth Longfellow as a teacher, and student Chamberlain’s signed book from class is there.  A red velvet-lined chair sitting at a desk looks like a throne – and it is, brought there by Chamberlain as a gift from the Queen of England.  These details provide a rich tapestry to the intertwining lives of history.

Remarkable Legacy

Chamberlain and his wife were something of medical marvels of the age.  His wife had strabismus, which left her with a lifelong vision problem, despite attempts at surgical correction.  Chamberlain’s pelvic wound, which left him with a permanent limb for life, also left him with a damaged urethra, requiring a catheter.  Having received 6 wounds in the course of the war, he lived a remarkably active, long life and was a “happy man”, by all accounts, according to the docent, shaking his head in disbelief.  Like many of the day, several of their 5 kids died of “consumption” – tuberculosis – in part because all 4 boys slept together, since the cause of the disease was not known.  Chamberlain has a personal nurse for much of his later life, to help given his mobility limitations.  The challenges of growing older echo across the ages.

One reason we know so much about Chamberlain’s life is that he wrote so much of it down for us.  While the Civil War soldiers were a remarkable literate lot, Chamberlain was an academic and gifted prose stylist well beyond average.  He left behind vivid, first-hand accounts of his experiences, and he was happy to take a starring role in the script.  Some have criticized him for this, complaining that he, and his defenders like Shaara, have glorified his place in history, while pushing others equally worthy to the side.  People like Gouvernour Warren and Strong Vincent, equally valiant and arguably more important participants on Little Round Top, have been relegated to supporting roles in the story, despite their actual importance exceeding Chamberlain in historical fact.  There’s something to be said for making sure to get your own side of story out – which I try to use as inspiration.  I also encourage those with time and inclination to read the relevant history and decide for themselves the truth.   By any measure, Chamberlain had a fascinating story to tell, and we are lucky to have it to learn from.

Chamberlain’s remarkable life has been an inspiration for this academic over the years.  His bold decision to leave the safe confines of the academy – his took a leave of absence, promising his bosses and his mother he was going to Europe to study – and raise volunteer troops to fight for the noble twin causes of “union” and “abolition” challenges me to pursue my inner beliefs.  That he taught himself the military arts and rose to the rank of Major General, even in those times of rapid ascension via attrition, illustrates true self-sufficiency and personal growth.  His magnanimous gesture to his defeated opponents showed a generosity of spirit, especially coming from someone nearly killed by those adversaries-turned-countrymen.  Would that we all could muster such courage and grace when the telling moment calls.

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Filed under Aging, Civil War, History