When a Housecall is Worth a Thousand Tests

Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that?

Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren for holidays and summer vacations. After Eli died three years ago the large house had become a millstone around her neck and she had lowered her asking price by more than half before it finally sold. She had confided in me last spring that she didn’t think she could handle another winter there.

She had been so excited when she told me about the cute little apartment she would be moving into in September.

Then in November, I saw Flossie with a concern about nighttime coughing. She had gained some weight, but of course, she wasn’t running up and down three stories and down in the basement anymore.

She confided in me that she wasn’t thrilled with the apartment complex she had moved into. There was loud music and neighbors’ late night arguments sometimes kept her awake.

Her EKG and chest X-ray were normal, and she wasn’t anemic, but her BNP was mildly elevated. I ordered an echocardiogram. That was normal. As I contemplated my next move, Flossie ironically broke her ankle slipping on the wet bathroom floor. She never injured herself feeding the fires in her Victorian, but a wet tile floor put her in a cast boot and crutches.

I needed to proceed with my assessment of her cough and shortness of breath so I offered to do a housecall.

The first thing I noticed when I arrived at dusk for my visit was that several light fixtures outside and inside the building weren’t working. I also heard the music Flossie had told me about as I walked down the dimly lit carpeted hallway.

Entering her ground floor apartment at the back of the building, my nose instantly registered a strong smell of mold and my mucous membranes started to burn.

Flossie was sitting in a recliner with her injured foot elevated and as we spoke, her conversation was interrupted now and then by a dry cough.

“Did you see all the broken lights and did you hear the thumping rock music coming in?” Flossie asked. “I should have moved into the Leblanc Apartments instead – they have more people like me there. My best friend Norma Beck lives there, you know her. The Superintendent there has said I can have an apartment close to Norma’s that becomes available the first of next month.”

“Sounds like that could be a good change for you”, I said, and I thought to myself as my eyes watered from the mold in the air, “it might stop our breathing work-up right there”.

1 Response to “When a Housecall is Worth a Thousand Tests”

  1. 1 meyati January 19, 2015 at 1:05 am

    This happens to older women. I hope that she can really afford to move. The fear of not having enough money, or actually not having enough money, causes the safety and health issues overcome the women. I can’t think of the term, but social workers have a name for this sad event. Something like “The Socio-financial downward spiral of older widows that causes physical and mental health problems.” This includes break ins, muggings, bullying, rape. It’s also called socio-economical deterioration of older single women-something like that. They desperately try to hide this.

    I hope that her children care for her instead of them ripping her off. So many old people transfer property to their kids, and the kids sell it out from under their parents. The parents trust their children or grandchildren, and want the money to go to their children and not to estate taxes. Power of Attorney is another way the children fleece their parents. I started hearing occasional complaints about this in the late 198os.

    I was walking my hounds, and this woman in about her 80s was walking down the street, followed by 2 women doing an assessment, clipboards and all. She looked, and I smiled. I sat the dogs down, and asked her if she wanted to pet the dogs. We talked like we knew each other. She kept telling that I had a beautiful Bluetick and Walker. One of the women asked what breeds the hounds were. I told them- and some of the breed history. I asked the woman how she was doing and answered.

    We said Good-bye and I’ll see you later. I never saw her before or later. I didn’t have a clue where she lived. I just pray that her children or whoever didn’t kick her out of home. There was a lot of that, fueled by the fact that the mayor’s wife had a real estate company that condemned homes, especially the elderly. I was talking to some police officers after that. They were thinking of getting hounds for their families. They told me to never let the city in the house, especially utilities, because they had to go to condemned houses, and as far as they could see, nothing was wrong.

    I do hope that your patient was telling you the truth, and does have a place to go. I hope that her children didn’t snooker her out of her money.

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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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