“It's been a bad day,” the older man sighed. His brow furrowed as his gaze settled on the stretcher where his wife lay in ED room 9.
She was not a new patient to our ED, although this was my first encounter with the couple. Her body was wracked with painful spastic tremors, a result of her advancing Parkinson disease. Because she was unable to speak, her husband explained the situation. He served as her primary caretaker, and today he became concerned that her “episodes” were coming more frequently and uncontrollably.
“Ativan and morphine usually work for her,” he remarked. A duffel bag filled with his wife's prescription medication bottles and medical records sat beside him. I don't often see quite so many meds brought in with a patient.
As the conversation progressed, I learned about his wife's diagnosis of early-onset Parkinson disease at age 47 years.
“I've been taking care of her for 15 years now, but I felt really scared today. I didn't want to be responsible if something bad happened,” he explained.
My attention lingered on the woman whose violent tremors were a visible reminder to her husband that she was, in fact, deteriorating. She had soft skin, long manicured nails, and even a tasteful amount of makeup on her otherwise paralyzed face—evidence that she was impeccably cared for at home. Her husband held her hand and murmured softly to her.
I ordered the lorazepam and morphine, and explained that I would return to reassess her symptoms after attending to a few of my next patients. The night was just beginning to pick up. A sprained ankle, a laceration, and back pain—quick hitters that could be treated and discharged swiftly. But my thoughts kept settling on the couple in room 9.
I returned to check on the progress there. The room was silent except for the soft sound of rustling sheets as my patient continued suffering from spasmodic contractions in all of her extremities.
“She's still pretty bad, doc,” her husband assessed. “Normally the meds work by now.”
So I ordered another dose, reminding myself that therapeutic interventions aren't always successful the first time. In the ED, it is hard to exhibit patience, as we are so often working to prevent permanent morbidity or mortality. This time it'll work, I thought to myself hopefully.
Shortly after, I was midstride between a postconcussion patient and a pelvic examination when a familiar voice summoned me from room 9.
“Do you mind keeping an eye on her?” he asked. I turned toward the doorway and noticed that the bags under his eyes seemed heavier than I had remembered. “It's just that I don't get much sleep anymore and I could really use a cup of coffee and a sandwich. I want to stay by my wife's side but I haven't eaten since this morning.”
It was nearing 10 p.m. My heart ached for this gentleman.
“I'll be back soon,” he said with a forced grin as he released his wife's frail, trembling hand. She blinked in acknowledgment.
Despite numerous rounds of medication administration, her body remained fitfully kinetic when he returned just a short while later. I was frustrated that I hadn't been able to fix the patient lying before me. I couldn't imagine her own frustration as the inhabitant of a body that was failing her.
“We may need to keep her in the hospital overnight in order to control the tremors,” I explained gently. “Is there anything else we can try that has worked for her in the past?”
He hesitated for a moment. “Well, sometimes when my wife is agitated at home, I just try rubbing her muscles like this.”
I watched as he gently massaged her right forearm, working proximally to the elbow. I followed his lead on the left, gingerly kneading the cords of rigid musculature beneath my hands. Without words, we worked in tandem. After the shoulders, we moved to her calves and I began to feel the tension in her frail limbs melt ever so slightly with our caressing touch. He began humming softly as we worked. We were making real progress in that moment—a moment of connection, a moment of healing, a feeling of success. An acute awareness came over me as I realized that I was participating in an act only before shared between this couple of 41 years in the privacy of their home. I was painfully and yet gratefully aware of the tender moment I was privileged to be sharing with them.
Sadly, the relief of her tremors was short-lived. They gradually returned, and we all agreed that the patient would be unable to go home in such a state.
“I just can't do this anymore by myself,” the husband agonized. A single tear rolled down his cheek. “Can you help me? I just don't know what to do anymore.” He was emotionally and physically exhausted; clearly he and his wife had endured the ravaging effects of Parkinson disease.
It was a painful admission, but it was reality. Instead of defeat, however, I could sense his relief at relinquishing his burden of responsibility for her care. And just like that, a neurologist and social worker were consulted, the admission orders were placed, and the couple was brought upstairs to their room for the night. As is the case for many of the patients that I treat in the ED, I am likely never to see them again.
So often as medical practitioners, we feel defeated when we aren't able to fix the problems presented to us. This especially holds true for those of us in the ED, where patients expect quick solutions for their ailments. Yet success can be measured by many intangibles encompassed in the art of medicine. As physician assistants, we have the privilege of touching the lives of our patients in an effort to heal. But even when a cure is not possible, we can still do so much for our patients and their families. A human connection, a caressing touch, a release of agonizing responsibility—these were the successes on my shift that night in room 9.
