Grandma is coming over for Thanksgiving.

Working Holidays

This year I worked Thanksgiving. It’s always busy and there are usually a few really sick patients but you can also count on the usual players. Here is a patient that every ER doc dreads seeing on the holidays.

Chief Complaint: Grandma doesn’t look right/ not eating/ feels weak/ vomited.

This one is guaranteed. Every Thanksgiving the extended family gets together and many haven’t seen granny since last Christmas. Spurned by guilt, the “love contest” begins. It starts when Grandma is abducted from her nursing home or assisted living facility. The doting and concern begins. Granny has been force fed Turkey and dressing, potatoes, a mystery casserole and 5 pieces of cake. She also takes a shoe box full of medicines. Ultimately grandma vomits and this event sets off a 5 bell alarm. The “good” children spring into action. The best children are doing the Heimlich, knocking off granny’s wig. Others are preparing for CPR (no one wants the mouth to mouth), while others are calling EMS. Assaulted, granny doesn’t know what the hell is going on. My favorite family members are the ones who decide to just have another Egg Nog and stay out of the way. EMS arrives and brings granny to the ER with a convoy of mini-vans in tow.

The nurses arrive in the room and check things out. This usually means getting grandma alone, getting her wig back on, a shot of Pepto-Bismol and a glass of water. Everything is fine. Now the hard part: convincing the family.

ER doctor trick: Find the alpha male. This is usually the highest functioning member of the family, the one who knows granny the best. This is my best shot at diffusing the drama. This is also one of the reasons why we limit each patient to only two visitors. We typically run a few blood tests and an ECG; chances are good these are going to be baseline values for the 85 year old.
Now time for discharge, this is where I get the dirty looks. Aghast the distant family cannot believe we are sending MeeMaw away. She’s old and she vomited for God’s sake! She needs a stomach transplant! This is not what happens on television! They are sure she is having a heart attack or a stroke or some other medical catastrophe. Truth is she’s not. The problem is I can’t guarantee that she won’t have any one of these next week. People love the guarantee. A cruel fact of life: There are no guarantees in medicine. “All the screening test look okay”, I tell the family, “Let’s get her back to her normal routine and I think she will be alright.” The alpha family member understands but smartly keeps quiet. He or she knows better, let me be the bad guy. The lost sheep of the family usually chimes in with this thinly veiled threat “Well she better be alright!” Checkmate.

Knowing I can’t win here, I grab the next chart in the rack.
Chief Complaint: Turkey baster is stuck somewhere it doesn’t belong.
Nice.

Patient Tip: (also one of Doctor Gibson’s ways to save health care). This one has to do with grandma and her shoebox full of medicines.

If you are over 85 years old, stop taking your cholesterol medicine.
WHAT! You read that right. If you have reached the extremely golden years you can lay off the cholesterol meds. Chances are they are costing you over 50 bucks a month and what are we really doing here? If you are 85, I say you have earned the right to eat and drink whatever you want. If you just want dessert, fine. If you just want to eat 5 desserts, fine. Want to take up smoking? Fine. You have beaten the average, you’re 85! You won. So take that 50 bucks a month and buy yourself a cheesecake. You’ll like that better anyway.