I was working during a night shift. It was mostly quiet. It was time for the rounds, and as usual I were to visit “problematic patients” and ask the nurses on each floor if they had something new to report.
It was indeed quiet, scary quiet; I felt as if I were the main actress of a thriller movie waiting for something exciting-scary to happen at any time. I was done with my rounds and nothing had happened to my slight disappointment. I thought of chatting for a while with the French nurse of the floor I was responsible for in the past month during the day shifts.
She started complaining about the new computer program and the inadequecy of the management to solve the most banal problems. It was nothing new, they seemed the most popular conversation topics during that time. I apologised for the time-consuming program -as if it were my fault- but it seemed to work; she stopped complaining and smiled at me. I was puzzled as to why but didn’t give any more thought to it. We were soon talking about other things and started laughing, quite louder than usual.
“Mr A!”, I exclaimed suddenly. It was my Don Juan, a 90 year old -or so- patient with a lung tumor and pneumonia I had admitted two weeks ago. He was looking better this week after the antibiotic therapy, the tumor and the Parkinson’s considered. I greeted him and asked him how he was doing and why he was up wandering about at 10 o’ clock.
“I must go to my wife. She has Alzheimer’s and I am worried. The doctor told me that I can go at 10.”, I managed to understand after many repeptitions. You see, people with Parkinson’s disease do not talk clearly, something we physicians document as “dysarthria”.
“I know the problem with your wife and I understand it is worrisome. But it is 10 o’ clock, Mr Juan… 10 o’ clock at night…”, I replied smirking and thinking to myself “Sundowner again…”.
“Night?!”, he looked at me with a confused smile guessing I might be playing a joke on him.
I nodded yes and showed him the dark moonless sky.
Then, I turned to the nurse and asked her if he was planned for discharge the following day. She looked at me troubled and started going through the archived files trying to find the information.
He was still looking at me, my Don Juan, with a broader smile this time, or at least this is how I chose to interpret it considering what we physicians document as “hypomimia”. You see, patients of Parkinson’s show a decreased facial expression, as if they are wearing a mask or as if they have undergone botox injections.
I smiled back. I told the nurse to check his vitals and I ran a quick physical examination on him. The amazing thing when admitting and already knowing the patient is that in a case of a new symptom, one can clearly state the differences. You see, confusion shall not be taken lightly in the medical practice. It may be a sign of something more alarming ranging from low blood glucose or oxygen, a new infection, a seizure, a brain tumor, a stroke, medication, a heart problem, and the list goes on… Once his vitals and physical were as usual and the patient himself realised it was indeed night, I splitted my sides confirming my first thought.
“Mr. A, let’s get you to bed, shall we? You need a good night’s rest today. Tomorrow, when the sun comes up, you can talk about your discharge with my colleague”, I said and turned my head looking at the nurse. As she was escorting him back to his room, he paused and returned.
“What is it, Mr. A?”, I asked getting more worried this time.
“You see doctor, I am glad I got up. I got to see your beautiful smile.”
I laughed and blushed. My heart and brain were relieved.
“Thank you! Good night Mr.A!”, I replied parting the conversation.
I slept well that night dosing off to the meaning of compliments and honest laughter.
Mr. A was discharged as I heard 2 days later, being content and relieved to go back to his wife.