no. 21: cheating death...with parsimony.

as i sit before my computer in my 6th post-call haze, i am gladdened but the fact that i only have 1 more night of being on call for medicine. hooray! but then i go to the cardiac icu, which means more call. oh well. at least i am almost to the halfway point.

anyway, the past 2 call nights have been seen me admitting patients with similar problems. last week it was infected AV fistulas and other dialysis-related woes. last night it was people with chf and falls. that is not germane to the story i am about to relate, but rather is psychological defense mechanism on my part that i am using to help me feel better for the confusion i experienced on rounds this morning. i will admit that i got some details confused on a few patients, but in my defense, there were 3 gentlemen in their 70s who all had chf and leg swelling and who all came in between midnight and 2am.

moving on from tangent #2 to my humorous yarn: mr h was, as i previously noted, a man in his 70s with chf and leg swelling. we finished taking his history and then moved to the discussion of code status, that is, does the patient want cpr, electric shocks, etc., in the event that the "worst" happens? (i use the quote there for 2 reasons: first, i never say that because it seems, well, an inelegant and cowardly way to frame it, and second, because sometimes dying is a better option for these folks. i mention the latter as it related to discussions had with families who refuse to let their father/mother/etc. die even though that is what nature had intended for them long ago and who, in my mind, is being tortured by a combination of the ability of invasive medicine to keep them "alive" and their family's inability to make the humane choice.)

as i was saying: we got to the code status conversation with mr h he promptly informed us that yes, he wanted to be kept alive...at least until april. i couldn't refrain from asking him what was different in april. he informed me that it is cheaper to get buried in the spring and summer given the difficulty of being laid to rest in frozen ground. apparently cheapness is a force that cannot be constrained by mortal bounds. this was the first conversation all night that peaked my interest, so i probed deeper. he later revealed that he had "run some cemeteries," whatever that means, so he had the inside scoop on the scene. i then proceeded to inquire why, if he had friends on the inside, couldn't he get a deal? he informed me that he had secured a plot for his final mortal remains at a substantial discount, but that there was no flexibility on the "landscaping costs," which he assured me, were "significant."

i am, after all a doctor--someone who fixes problems, so i chimed-in with my sagacious wit and wisdom. the suggestion i offered first was cremation. he said that was an impossibility as he had already secured the aforementioned deal on a plot. he also was afraid that it would "hurt." i posited that a rapid burn at high temperatures might be more comfortable than a slow decomposition in a box whilst underground might actually offer less discomfort, but he was unbending. i paused to consider this quandary and arrived at the following answer: shovels. why not have his family dig his own grave? at this point i should mention that our previous conversation had involved a lengthy diatribe on his part on the ingenuity and stoicism of his family, so that wasn't as inappropriate as it sounds. he hesitated. i suggested that this was actually a grand plan since it would provide the family with a final memory of him. what better way to celebrate the life of the departed than discussing it while digging his grave in the frozen, january ground?

mr h, however, thought there would be many more efficacious manners in which to remember him and so alas, he remains full code.

SC