Do you ever have one of those days or moments when you think the stars actually do align for your patient's benefit? I had such an experience recently, but it didn't start off well.
I conduct hospital rounds on the weekends, and I am an early bird. So this means I may be the first advanced practice healthcare clinician newly admitted patients and their families see. One Saturday morning, I walked into Mr. C's room and found him in bed and his wife at bedside. She already had a scowl on her face when I entered the room, and at that moment I knew I should have stopped by Starbucks on my way in.
The wife lit into me and was clearly angry and scared. She said she brought her husband to the emergency room because he fell at home and had an arm fracture, and now she was being told something was wrong with him, but "no one is telling me what is going on!" As the patient person I am, I let her get it off her chest.
Calmly, I empathized with her and then shared with her what our group (the oncology and hematology team) was going to recommend on behalf of her husband. I shared with her that we were trying to rule out multiple myeloma due to some cranial lytic lesions showing up on the CT of his head (in addition to his recent arm fracture). I explained to her that some specific blood tests were still pending, and that the next step would likely be a bone survey.
This news of another test (the bone survey) caused her to go into another rant. Oh, boy. I listened, and she ultimately said that she didn't want him to have any more tests, and that she wanted to take him home.
Mind you, all this time, Mr. C was lying in bed listening and watching us. He was a young-old man and appeared to be quite healthy overall based on his medical history and my assessment. I looked at Mr. C and asked him if he would like any further testing, such as the bone survey. He shook his head and said he would do whatever she wanted him to do (meaning his wife). I again explained what the bone survey entailed and that it would not be invasive or painful. I encouraged them to think about it, discuss it, and let the staff nurse know when they had made a decision.
Before I went, his wife grabbed me by the arm and said, "And how come my husband can't speak anymore like he did before coming here? All he does is whisper!" I didn't have an answer for her. I asked Mr. C if he was having pain when he swallowed, etc., and I reassessed him.
I left the room and headed straight for the coffee room. Decaf, ugh.
Several hours later, at the end of the day, I was back on the unit for a new consult. Mr. C's wife was in the hall looking as if she were looking for someone. When she saw me, she came rushing over to me. Uh, oh.
She looked at me and started crying. She said she was sorry for yelling at me, and she shared that they had talked and did want to proceed with the bone survey we had recommended. I reassured her and listened to her fears.
The next morning, I was back on the unit. The staff nurse found me and asked if I heard what had happened to Mr. C. She went on to explain, when they got the bone survey results the previous night, they found Mr. C's (partial) dentures were lodged in his throat, right above his epiglottis. No wonder he couldn't speak well.
An ENT was being called in to evaluate and retrieve his partial dentures. No one knew if this happened when he fell or sometime afterward. And neither Mr. C nor his wife had realized his partials were missing. The rest of us talked about how we noticed he had a couple of missing teeth, but we are in Kentucky, and we see missing teeth on a daily basis with our population.
Thank goodness they agreed to the bone survey, or who knows how long those partial dentures could have been lodged there.
Have you ever had a test find something so unexpected?
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