The chief complaint, “altered mental status.” I glanced quickly at the age—89 years old. I read through the history—dementia, high blood pressure, arthritis. The triage note was vague, just that the husband had noticed that the patient was “confused.” No specifics given. The vitals signs were normal. I knew before going in the room what I would do. After all, I’d seen this same patient a thousand times before. Head CT, labs, ekg, urine, admit for observation. My money was on the urine. My money is always on the urine if the vitals signs are normal. I slowly picked myself up from my chair, sighed and headed into the room. Actually seeing and examining the patient seemed so unnecessary.
I walked in and introduced myself to the woman sitting up so very straight in the bed. “Hello,” she replied, her handshake firm.
“And who is with you today?” I queried, gesturing to the man across the gurney from me. She stared back quizzically.
He nodded a bit sheepishly and then said, “I’m her husband.”
She kept looking at me, a mixture of interest and distrust on her face.
I asked what was wrong, how can I help. “I’m fine,” she said. “There is nothing wrong.” Her longer statement allowed me to hear her accent better, the familiar cadence of someone born and raised far from the little hospital room we now occupied together.
I started my litany of questions, beginning at the top and working down.
“Are you having headaches?”
“No,” also to cough, fevers, abdominal pain and diarrhea. No to everything.
Her eyes were so bright, her gaze so focused, her answers crisp and brisk.
“Can you tell me where you are today?” I asked, fishing for more information than just our location.
Her brow furrowed for just a moment and she paused, a look of panic deep in her eyes. I paused, giving her a moment which clicked into another and then another.
“How about what state you are in?”
“What state am I in? What do you mean?” Her voice became shrill and she looked over at her husband, seeking the answers in his face.
“That’s okay,” I said, trying to calm her down but still needing more. “Can you tell me what the date is? How about what month it is?”
She looked at me intently, anger rising up from her chest.
And then she started to swear at me in German, her tone implying her frustration with my insolence, even if I couldn’t understand the words.
I started to examine her and as I did I said, “Tell me where you’re from.”
“Well, I’m from Germany, of course,” she responded, transitioning seamlessly back to English.
We talked some more then. She was born in Germany. She’d met her husband during the war, a young GI from Pennsylvania. They’d married in Nürnberg, and she’d immigrated here. Her voice calmed and she relaxed back on the stretcher, the memories of 60 years ago easier to conjure up than today’s date.
I thought of my Omi and the parallels between her life and the woman’s before me. Surviving World War II, settling in a new country, a life far from the one she’d known growing up. Fierce pride in her homeland. The slow decline into confusion and dementia. Hard stretchers in the Emergency Department. People asking where she was and why was she there.
My grandmother was far from a pleasant woman. Even before the dementia, she could be rude and entitled. And there is no doubt in my mind that she’d bitch out a doctor if she felt they were prying to much or if they were revealing how much she didn’t know, how much she couldn’t remember. She’d break out the mother tongue all right and she’d let them have it.
But there was another side to her as well. A side that loved her family, however imperfectly. That loved to tell stories. That missed the familiar and the well-known.
I hope, that in the midst of her swearing and thrashing about the Emergency Department, that someone asked her who she was. Not our usual questions of “Where are you? What is the date?” but something she could answer. I hope she got to tell her story, at least a part of it. And I hope that someone listened. Perhaps someone even smiled a bit, thinking of their own grandmother, or their Oma, or their Abuela, or their Nonna. I hope that she was missed, whoever she was.