Bones like porcelain, soul like a sage.

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Author: Jocelyn Chase
Date: Apr. 25, 2022
From: CMAJ: Canadian Medical Association Journal(Vol. 194, Issue 16)
Publisher: CMA Impact Inc.
Document Type: Article
Length: 1,961 words
Lexile Measure: 1130L

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I met Ms. T on a busy day, the last patient on my rounds in the late afternoon. My feet were dragging, my spirits lagging, stomach hungry and patience short. I resigned myself to the infection control alert at the door. Earlier that day, a patient in the four-person room had tested positive for SARSCoV-2 infection, and now Ms. T and her two remaining roommates were prisoners to infection control. I donned the stifling N95 mask, face shield and gown, immediately hot and irritable.

On meeting Ms. T, I could see that, at 86 years old, she was sharp of mind but frail of body, weighing only 80 pounds, less than 1 pound for every year of her life.

"How is your pain today, Ms. T?" I asked, hoping that it was better so I could finish up and head home, to cook dinner and do homework with my two young children.

"Terrible!" she said. "That gabapentin makes my mouth so dry and my head too fuzzy. I told the nurse to take it away."

Frustration welled in me, as it sometimes does when patients don't conform to my expectations and I am feeling depleted by a long day. "Why can't she just get better?" I thought. She had been admitted almost 2 weeks ago and, although she could walk gingerly to the bathroom, her left-sided sciatica and hip arthritis were bad and she couldn't go home.

"Fine--let's try an epidural," I replied briskly. I explained the procedure, hyping its success in other patients, convincing Ms. T and myself that it would be a great option for her, given her preference to avoid oral medication. Eventually she agreed with me, putting her trust in a doctor she had never met before.

The epidural did not go well. "The patient experienced sudden pain in the left hip and knee, and the procedure was stopped just as the local anesthetic was being injected," stated the report. What did this mean? I had to find out what had happened. On the ward, the nurse told me that Ms. T could no longer fully bear weight on her left leg, and had taken to transferring to and from bed by sitting on her walker, pedalling herself around the room with her feet. She could still get to the bathroom on her own, but it was a step back.

"They were rough, flipping me over, and I felt a sudden pop in the back of my leg," she declared.

"Surely not," I thought. Surely not that rough.

Her range of motion at the left hip was surprisingly full and I was somewhat reassured that the pain was an exacerbation of her known severe left hip arthritis and sciatica. I would have felt better sending her right back down to radiology for imaging

"just in case," but at that point Ms. T was fed up with doctors telling her what to do. We both agreed to...

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