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The Differential

How a Heart Breaks

Rick Pescatore, DO, Emergency Medicine, 02:10PM Jan 12, 2014

The Trooper was waiting outside tonight as Sam and I pulled up to the address displayed on our glowing screens. A white strobe flashed over his face and we both mumbled our approval--"Ah, it's John. He's a good guy." I hopped from the passenger seat and slung my red bag across my chest as he walked over to the rig. John didn't have much info for us. A fall, maybe a broken leg. He'd managed to corral most of the pets in a room off to the corner. "Wear your masks, guys--it's pretty bad in there." We chuckled, but John wasn't smiling. He'd be waiting otuside as we tended to the patient within.

Several days worth of newspapers littered the driveway as I walked to the door, a white plastic portal concealed behind layers of filth and mold. The rusted springs groaned in protest as I pulled a broken handle and entered the home.

We were almost thrown backward by the overpowering putridity. The smell of stale litter, molding food scraps, and raw sewage infiltrated every pore and filled each nostril. Piles of pizza boxes abutted stacks of old newspapers and magazines. Bottles and cans covered a cloth couch, itself bearing dozens of stains of every color. Cat litter sprinkled every inch of flooring, and we dodged continuously as the animals dashed back and forth, sent into a frenzy by the rush of visitors. A woman sat quietly on the floor, her back to the kitchen counter. "Not again," I sighed to myself. My heart broke at the sight of another patient who'd been left needing help for days.

Audrey had fallen while making breakfast. Unable to reach the phone, she'd resigned herself to waiting out the pain shooting down her leg. When it felt better, when she was strong enough, she would crawl to her bedroom and call for help. That was three days ago. Since then, she'd sat quietly, her cats for company and the kitchen TV playing continuously. A few boxes of cereal were within reach, and she munched on chocolate crisps as the hours passed. She couldn't reach her medicine--the insulin and beta blockers that sat on the bathroom counter--but she figured a few days wouldn't hurt.

When she needed to use the bathroom, she had no choice but to relieve herself where she sat, and days worth of waste fermented all around her. The already-filthy home grew more noxious. She vomited, but, again, there was no rush to the sink, no cloth with which to wipe her face. As Audrey's blood sugar climbed higher, she felt thirstier and thirstier. The kitchen sink, just a few feet away, taunted. Her cats cried out to be fed.

John's a good cop. Driving by, he had noticed the accumulation of newspapers.With a car in the driveway and light shining inside, he thought it prudent to knock on Audrey's door--a decision that likely saved her life. With no family to speak of and no obligations to attend, it could have been any number of days until Audrey was able to call for help. As it stood, her blood sugar was over 600, her blood pressure nearly twice normal. When I pinched Audrey's forearm, it remained fully tented and rubbery to the touch. Her cracked lips and white tongue pulled air deeply into fibrotic lungs. Her heart raced.

We quickly loaded Audrey into the waiting ambulance and set off for the hospital, and I worked silently in the back even as my confused patient insisted that we take some of the cookies she'd baked a few days earlier. Soon enough, Audrey's mind began to clear, but she could think only to apologize for the state of her home: "ever since my husband died, I just can't keep up..." I nodded and smiled. As we bounced down the long road to the hospital, we talked about what had happened, what went wrong, and how she was feeling now. When all the bases were covered, the conversation turned to TV shows--her favorite episodes and characters. We chatted about the Moon, unusually bright and sharp tonight, and the glowing stars that filled the Pennsylvania sky. Despite the pain in her leg and the ache in her back, Audrey was thrilled to have someone to talk with, and I was happy to oblige as we neared our destination.

The turnover went smoothly. A largely unfilled ED held plenty of room, and nurses and technicians were ready immediately to help Audrey out of her stained clothes and into a hospital gown. I swung the curtain behind me and spoke softly to the nurse assuming care. He listened as I told him of the scene and nodded in agreement at my suggestion to ask social services to approach Audrey about assisted living. With that, I peaked back into the room where my patient now lay, her second bag of saline running swiftly into her arm. I waved goodbye and headed back out to the rig to prepare for the next call.

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