Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [73]
“Mom flat-out refused,” Naomi said. Instead, she followed a naturalism orientation. “She did positive imaging, focusing her mind on the area that wouldn’t heal,” Naomi recounted. “And a friend of hers went to a special beach and brought back seawater that Mom bathed the area in. After a few months, it closed.”
Never one to mince words, Ruth told Naomi that she was “tired from all the surgery and hospitalizations and never wanted to go to the hospital again.” She wanted to do everything possible to stay healthy enough to be present for joyous occasions with her family. But she was clear in her limits.
When Ruth was seventy-four, she went on a long-planned trip to China. She was fascinated by the East, was thrilled to tour the Forbidden City in Beijing and climb to the top of the Great Wall. When she returned home, she told Naomi that she was happy she’d made the journey, but she just wasn’t feeling well. She had developed a persistent nagging pain in her chest. Her primary care doctor ordered X-rays. A wire placed to close the breastbone at the time of her heart surgery had now loosened.
“After that, she had good days and bad days,” Naomi said. “She struggled to live with the pain. She did not like pain medication, not at all; she said it made her feel druggy.”
Over the next year, Naomi found Ruth spending much of her time in bed. “This was not my mother,” Naomi told us. Ruth was the one who organized events for the sisterhood at the synagogue. She also kept track of members of the congregation who were ill, writing them notes wishing them a rapid recovery; if she knew the person, she would call and offer words of encouragement. But Ruth was finding it harder and harder to keep up these activities. Then, in early winter, Naomi called on a Saturday afternoon to check on her mother.
“I feel terrible,” Ruth said. “I couldn’t go to shul. I need to see my doctor.”
Naomi reminded her that it was the weekend. If she needed to see a doctor, she’d have to go to the emergency room.
“Then take me,” Ruth replied.
Naomi was shocked, “because I knew how much my mother hated the hospital. Whatever was going on had to be serious.”
Naomi picked up Ruth at her home ten minutes away. Ruth gave her a weak hug and planted a kiss on her cheek, as she always did when they met. Naomi tried to keep one eye on Ruth and the other on the road as she drove to the hospital.
“I don’t know what’s wrong, but something is really wrong with my mother,” Naomi told the triage nurse. In short order, Ruth was taken into an examination room, where her blouse and slacks were removed and replaced by a hospital gown. The nurse checked her blood pressure, then took it again.
Ruth was sitting on an examination table, staring intently at the nurse. “Why are you checking my pressure again?” Ruth asked.
“You might feel better lying down,” the nurse said. “Your blood pressure is extremely low.” The upper number is normally 120; Ruth’s pressure barely reached 70.
Naomi retreated into a corner as the room quickly filled with medical personnel. A technician placed an IV line into Ruth’s arm, while EKG leads were applied to her chest, arms, and legs. She was then examined by a young doctor who introduced himself as the ER attending physician. “I feel terrible,” Ruth told him.
The doctor asked, “Are you having any pain?”
“Not really. Well, I do have this pain over my breastbone, but I have had that for months,” Ruth said. “I just feel awful, so awful.”
The doctor explained to Ruth that she was on the cusp of going into shock. “You don’t look sick, but you are,” he said. “And we need to know your wishes if something would happen, if your blood pressure were to fall even lower.”
“I have an advance care directive. My daughter