Abnormal Chemistries

On my way to the hardware store this morning, I saw an old patient waving from her front porch rocking chair. By all accounts, Clair Schultze should not be alive today. Now in her mid-eighties, she suffers from fairly advanced chronic kidney disease and anemia. Two years ago she had a small heart attack and developed atrial fibrillation. Then, just after last Thanksgiving, she had a stroke.

It was a large brainstem infarct. She was in a coma for several days and her three sons flew in from their opposite corners of the country to comfort their father and help him decide whether to discontinue her life support.

The same day they decided to stop all heroics, she started to move her arms and legs a little. Within two weeks she was home, making final plans for Christmas dinner. She was weak, but she was still the same bright, witty Southern Belle and matriarch she had always been.

That is the way things are with brainstem infarcts – you never wake up or you make a full recovery.

In follow-up, Clair’s lab work looked much worse than before her stroke. From her anemia to her kidney function to her protein levels and salt balance, she looked like she should feel terrible, but she was radiant.

As for what to do with all the abnormal lab values, she told me in no uncertain terms:

“If you can’t promise that fixing the numbers would make me feel better than I do now, leave things alone!”

I shook her hand in agreement and we set a time for our next housecall, after the New Year. As I left, I looked back and saw her sitting in an almost Royal pose in her velvet wingback chair next to the decorated Christmas tree by the crackling fire in her tidy living room. I had the strongest sense that her will to live and to enjoy every moment was doing more for her than any of the medical treatments we might offer her.

I remembered the story of Mr. Fish.

When our children were young, they wanted a fish tank. They promised to take good care of it and to never tire of it. We agreed, but decided to put it in the built-in bookcase in my study. That way I figured I could make sure the fish were not neglected, and I would be able to enjoy the soothing movements of the fish when I sat down to write at night.

In the beginning, just as we predicted, the children gave the fish a lot of attention. Even Mindy, the Springer Spaniel, who was crazy about water and frogs, was fascinated with them.

The years passed and so did the children’s interest in fish keeping. Even Mindy ignored the few fish that remained, as age and unknown maladies reduced their numbers.

In the end, there was only one lonely fish left, a dapper, brightly colored fellow my wife and I called Mr. Fish. Whenever I entered the study, he swam up to the glass as if to greet me. I really enjoyed his company.

By that time, the glass walls of the tank weren’t as clean as when the suckers were alive, and the water had taken on a slightly murky quality. We joked that he had adapted to these seemingly unsanitary conditions so well that anything else would kill him. But then, the light and the bubbler both stopped working, and we felt we had no choice but to put Mr. Fish through a major renovation of his surroundings.

We should have known. Mr. Fish didn’t survive the change, even though we saved some of the old water and some of the old plants. The newly redone tank looked beautiful, but that was meaningless to him.

Ever since we lost Mr. Fish I have had a certain trepidation about intervening to correct abnormal lab values when the patient seems to be thriving in spite of them.

I think Clair Schultze is a lot like Mr. Fish in that regard.

3 Responses to “Abnormal Chemistries”

  1. 1 Sheri Booker May 27, 2010 at 3:06 am

    If I had a greenback for every time I came here! Incredible article.

  2. 2 Claudette Dominguez May 30, 2010 at 4:31 am

    Haha I’m really the only comment to this amazing article!?

  3. 3 Bridgett Gagnon May 31, 2010 at 11:05 am

    If I had a greenback for each time I came to acountrydoctorwrites.wordpress.com.. Great post.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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