Modules

Complexities of care of the elderly

Part 2

  • Dr. Shah: Thanks for coming down. I have a 78-year-old retired farmer with an infected leg ulcer — likely diabetic ulcer. He’s delirious, but I’m not sure if it’s superimposed on dementia. He’s accompanied by his daughter. I’ve sent off the usual labs including blood culture. He is febrile. I’ve consulted with Dr. Sakowski from surgery and he recommended an amputation.

    Dr. Edelman: Oh. An amputation.

    Penny: What! Did you say amputation? Now, now hold on a second. He wouldn’t want that. Can’t you treat him some other way?

    Dr. Shah: Mrs. Simons, this is Dr. Edelman, the internist who will take care of your father while he is here. You may have overheard us discuss some treatment options. I will let Dr. Edelman discuss these with you and your father.

    Dr. Edelman: Thank you, Dr. Shaw.

    Dr. Edelman: Mrs. Simons, it’s good the surgeon has had a look early on. Now if you don’t mind I’d like to see and talk to your father as well. Can we go in?

  • Dr. Edelman: Hello, Mr. McTeer, I’m Dr. Edelman. How are you today?

    Jack: Who are you? … Where am I? … What’s going on?

    Dr. Edelman: Mr. McTeer, do you know where you are?

    Jack: I want to go home … I want to go home.

    Dr. Edelman: You are at Thornbury Hospital, Mr. McTeer. Are you in any pain?

    Jack: I’m good, I’m good …

    Dr. Edelman: I understand you might have a problem with your leg. Would you mind if I had a quick look?

    Jack: What … what the hell! Leave me alone, you bugger. What do you want?

    Penny: Dad, the doctor is trying to help. Tell us what happened.

    Dr. Edelman: Mr. McTeer, do you know where you are?

    Jack: I … home… home.

    Penny: No, no dad, you’re in the hospital. Don’t you remember?

    Dr. Edelman: Mr. McTeer do you know what day this is?

    Jack: Penny, Penny, go look for the cows. Go look for the cows, Penny.

    Dr. Edelman: Mrs. Simons, Mrs. Simons, has your father ever had any problems with his memory or mood before?

    Penny: No. I mean he’s stubborn and grumpy, never exactly cheerful, but not like this. It’s only been three weeks, how can he have changed so much?

    Dr. Edelman: Well, does he drink any alcohol?

    Penny: No, just tea.

    Dr. Edelman: And aside from the diabetes and blood pressure problems, do you know of any other health issues?

    Penny: No. But Craig Stevens at the Plainsview Health Centre would know better. He’s the nurse practitioner there.

    Dr. Edelman: Well we’ll certainly get in touch with him. For now we’ll run some tests and we’ll start treating the infection. We’ll see how he is tomorrow. We can meet again then and talk about it. How does that sound?

    Penny: I’d like to but I can’t. I have to work tomorrow. The only reason I’m here this Friday it’s, it’s because it’s my weekend to work. I usually see dad on weekends.

    Dr. Edelman: In that case, Mrs. Simons, don’t worry, we’ll get in touch with you if anything changes, alright?

Reflective exercise 1


 

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