Diagnosis

This is a Daughters in Medicine post.

(which really does describe me - I'm a third-generation doc. And that is and isn't relevant to this post.)

When my grandmother was in the last years of her life, she fell out of bed. They took her to the ER, where she was Xrayed, pronounced intact, and sent home (where she lived with my grandfather, the retired internist, and a full-time caregiver.) The next morning my mother called me and said "Your grandfather is upset because your grandmother refuses to get out of bed." This was in the 1990s, before digital radiology and Nighthawk came along. I said "Tell him to call the hospital and ask for the radiologist's interpretation of the film. She might have a non-displaced fracture that the ED doc didn't pick up." Mom called me back several hours later and said - in a deeply suspiscious voice - "How did you know that?" I said "You sent to medical school. I learned stuff."

It's now 25 years later. My mother is the one with dementia, living at home with 24-hour care. No retired internist in sight; my father died nearly ten years ago. Last week Mom fell. The caregivers thought she was OK; a few days later, the pain was worse and she was refusing to bear weight. I said "She needs Xrays; she might have a nondiscplaced fracture." And sure enough. She sent me to medical school. I learned stuff.

Mom doesn't need surgery, thank heavens; we'll get equipment into the house and she'll stay in bed most of the time for a while. She's not having any pain.

But I know what it means when someone with moderate to advanced dementia breaks a hip. I'm a palliative care doc. I know where we're going. She sent me to medical school. I learned stuff. And some days, that stuff breaks my heart.