MGordon_MD
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Dec 9, 2009, 7:59 AM
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Nothing like an '88 Olds - From his memoir Brooklyn Beginnings
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By Dr. Michael Gordon
Sometimes physicians do their best to convince patients of the necessity of a treatment, and, no matter how hard the physician tries or how compelling the physician believes the logic might be behind the treatment, the patient refuses. This can even occur when the treatment is so likely to be beneficial—even life saving—and when, unlike with some other treatments, the risk of having the procedure is very small.
“I will not have any heart surgery,” was the adamant reply from Samuel Wolfson, an eighty-two-year-old man living in a retirement residence where I ran a geriatric clinic every week. “I am too old and will not have anybody cutting me open.”
I tried to explain. “Mr. Wolfson, this is not surgery the way you think of a really big operation. It is hardly surgery at all. Putting in a pacemaker has become a very minor procedure, and the cut is just a small incision to put in the pacemaker unit, which is much smaller than a hockey puck.” Samuel had been having fainting spells out of the blue, and a twenty-four-hour continuous Holter monitor had revealed, without question, pauses in his heart conduction that required a pacemaker to prevent a stoppage that could be lethal—either because the heart might not start again or, more likely, because the stoppage could lead to a serious fall and a fracture or injury to his head.
I was running out of arguments. I had even tried bringing in Eva, another resident of the retirement home who, the year before, successfully had had a pacemaker inserted and no longer suffered from falls. (A previous one had resulted in a broken arm; she had been lucky.) Eva agreed to speak to Samuel, whom she knew from some of the social programs they attended together. She would speak to him about what a simple procedure it was and how much it had helped her.
“Samuel, don’t be foolish. This is not a heart operation. It is over in an hour or two. I was home the evening of the day they did it. You hardly know you have the thing in place—it is just under the skin.” She was a very open and dramatic speaker. At this point, to his surprise, she grabbed his hand and pulled it up to just above her left breast and said, “Here, feel it? You would hardly know its there. It’s not very big you see. Can you feel anything?”
I could see the look of slight embarrassment on his face as she pushed his hand to just above her left breast and pushed it around. The pacemaker would have been just underneath his hand. After she left, he said, “I don’t think so. Thank you for trying to convince me. I think I will just let whatever happens, happen.”
I could not think of anything else to say. But then I thought for a moment and asked, “Samuel, what kind of work did you do before you retired?” I knew from his accent that he was probably an Eastern European immigrant, but his English was very good and very fluent, with only the mildest hint of an accent. He looked at me and said, “I was a traveling salesman—lady’s garments. I represented some of the best manufacturers in Toronto and drove all over the country. In those days, it was the only way. The car was full of samples, and I just drove from town to town and visited all the shops. Some were already established customers, and some were potential customers. I did it for thirty years, and only retired when the driving became too much for me.”
“You must have either loved the driving or had a lot of patience,” I added.
“I actually loved the driving. I tried to keep it to two- or three-week trips at the most, with a good break in between. I was away a lot from home. My family understood, and I made a good living—hard work, yes, but it kept us going with a pretty nice lifestyle and sent my children for their education. It was pretty good.”
“Samuel,” I pursued, “I was wondering, with all that driving, what kind of car did you drive? You must have needed something reliable.”
“I owned and drove only Oldsmobiles—the ’88 model with the V8 engine. What a car … it never let me down. I kept them in good shape, mind you—oil changes, brakes, and good tires … what a car.”
“So, I guess when the battery went dead, you just dumped the car—got rid of it?”
Simon looked at me incredulously. “Why would anyone dump an ’88 because of a bum battery? No, I would get a new battery.”
“Did that ever happen to any of your cars?” I asked conversationally.
“Of course! Once—in Winnipeg, I remember—it got real cold, and I guess I had kept the battery a bit too long. I was supposed to drive to Brandon, but the car was dead. It took a few hours, but, with a new battery, I was on my way—that car could really drive. And, even with the delay, I got there just a bit later than I had planned.”
“Samuel, that’s exactly what I have been trying to tell you. You are better than an ’88! You are a great model person, but your battery is not working—in fact, it is a bum battery that may soon give out. What you need is a new battery—that is what a pacemaker is … a new battery for a great model. Don’t throw the model away—it’s got lots of miles left in it.”
Samuel looked at me. Clearly, I had given it my last best shot. He broke into a smile. “Now that you explain it that way, I understand. Sure, I will get a new battery—what do I have to do? And naturally, doctor, I want the best brand you can get,” he said with a broad grin.
We shook hands and I told him we would make the arrangements.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on Mar 23, 2010, 11:27 AM)
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