“Say Ahhh”

I saw a patient last week who didn’t have a tongue.

Pretty soon after I began my interview I noticed that this man had a severe speech impediment. (nothing gets past Dr. PP!) We were relying on hand gestures and some writing on his part to communicate. My mind was racing!

……He has a neurological deficit…. Stroke. …Brain tumor…. Acute delirium secondary to medications….. Yeah. That sounds smart…. It’s probably that…..

Me: Can you say ahh for me?

Patient: aaaaaa

Me: Say ahh and stick out your tongue please?

Patient: aaaaaa

Me: hmmmm

……. Where is his tongue?!….. Is it somewhere in this room??…… Does he have a prosthetic tongue?….. I bet those are really expensive…..I should patent prosthetic tongues and get really rich…….

Thankfully this man was unbelievably patient and eventually explained to me that he had lost his tongue following mouth and throat cancer. Everything was smooth from then on until my attending came in the room…. and asked him to say “ahh”.

CAN WE GET A SIGN ON THE DOOR???? THIS MAN HAS NO TONGUE!

Fumbling

I recently started a preceptorship in palliative care. It sounds like it might involve dinosaurs (paleontology) but it is actually a medical specialty focused on end-of-life, comfort care. The strict definition is this:

“interventions that help the patient achieve comfort but do not affect the course of a disease”

It is a little bit hard to swallow. You most likely won’t be saving lives or diagnosing a new disorder. There might not be a riddle to solve. My checklist for a comprehensive physical, from palpating the distal interphalangeal joints to testing the cranial nerves seems a little bit silly. Or a lot silly.

My main concern when I found out that this is what I would be doing for the next few months is how the families of the patients would view me. At this point in our schooling the emphasis is on thoroughness and, unfortunately, passing our board exams. As such, we need to be proficient in going through the entire check-list. Correctly and tediously. Totally understandable! But I was having trouble visualizing walking into a room with a terminally ill patient and having to explain to their family that I need to check the strength of their loved-ones bicep, because my grade depends on it. No, I’m not here to give them pain meds, I just have to feel all of their pulses, even the femoral. Thanks for letting me practice on grandpa.

Thankfully it wasn’t quite as awkward as in my imagination. Still kind of awkward because I dropped some of my notes under the patient’s bed, but I think I recovered nicely. It’s amazing how something as simple as talking to your patient, even if they can’t hear you, puts YOU more at ease.

Having a great teacher and mentor makes all the difference in these situations! My preceptor was calm, explained everything to me in “easy” words, and encouraged me to ask questions. Looks like I have another excellent doctor to look up to!

In other good news, remember Milo’s twin? He was the pick of week at his shelter and got to take a picture with the mayor! How cool!

Adopt a dog!

In worse news, Milo did this:

There’s a pill bottle in there…. luckily it was his pills so we didn’t have to go back to VERGI. Like we could afford it!