One and Only

Chapter 2 - The Time Vacuum

Sure enough, by 9:15, she was only just getting roomed, since the immunizations for the twins had taken a long time to get together, and the HgbA1c machine (that we use to monitor patients with diabetes) was on the fritz. These delays had made the 8:40 diabetic patient run long. By the time I got into the room it was already 9:37 and I could tell just by looking at her that I would likely be in there for an hour.

One of the cruelest parts about aging in America is that most elderly adults are lonely, and that is precisely what her problem was. She had never married, had no children, and did not have any relatives in Salt Lake. Her diet consisted primarily of McDonald's, other fast food, and cheap frozen dinners, since she didn't know how to cook and that was all her budget would allow. She was morbidly obese, and as a result, had arthritis in her knees, hips, wrists, neck and back, and her blood pressure was difficult to control because of her frequent dietary indiscretions and because she inconsistently took her blood pressure pills.

I reviewed her vitals in her chart, which showed that her blood pressure was very high today at 167/97 and she reported to my MA a host of new problems: worsening pain in her neck, difficulties paying for her medicines and problems tolerating one of the medications for her diabetes.

There was no way that we were going to be able to address all of these concerns, and I could just tell that there was something else too, because she wouldn't meet me gaze when I shook her hand, and she was folding and unfolding a tissue in her lap.

I greeted her warmly, and shook her hand, pushing the computer away, since signing on and starting to chart was clearly not the best way to start our encounter today. "Good morning Linda, it's so lovely to see you. What can I help you with today?" I asked, trying to sound as warm and upbeat as possible.

"It's... well, my dog died three weeks ago, and I just..." she said, and then she started crying in earnest, unable to get the words out through her tears.

We had known each other for several years, and had had several interactions like this, so I knew that she would be ok if I touched her, so I scooted my stool closer to her and offered to give her a hug with open arms. She accepted and wrapped her arms around me and just cried for a full minute. I didn't say anything, or offer any kind of suggestions, I just let her feel my presence, let her know with our contact that I acknowledged her existence and her need to grieve for the loss of her dog, who had likely been her sole companion for many years. Gradually, she collected herself and pulled away.

"I just don't know what to do," she said, "I can't imagine my life without him. I haven't been sleeping or eating or taking my medicines at all for the past two weeks, I've just been in this fog." She wiped her nose with the tissue and looked up at me with her blood shot eyes.

"I know it can seem kind of sudden, but have you thought about getting another dog?" I asked, positioning my rolling stool so that I was still close to her, but so that we were no longer directly in each other's face.

"I'd like to, eventually, I just can't afford any extra bills right now, I'm having enough trouble as it is paying for my own meds," she said, looking down at the tissue again as she folded it and unfolded it over and over.

"Well, I hope that we can help you there," I said, scooting back to the computer to open her chart. "Why don't we have you meet with our clinical pharmacist and we'll see if she can't find some less expensive alternatives. I know that you've been having problems tolerating one of your diabetes meds, so it's probably time to think about other options anyway."

She nodded but did not look up.

"I'd also like to explore the idea of putting you on an anti-depressant," I said, cautiously broaching this topic again, as this had been an area that we had danced around one or two times before. "I understand that you have reservations, and I hear you, but Linda, I'm worried about you. I think some of what you may be feeling is because of depression, and that if you were less depressed, some of these other problems might not seem so insurmountable."