Giving patients good news

I was rounding at one of the rehab/sub-acute hospitals today. One of the patients was a 70 y.o. African American man who had undergone a kidney transplant 12 days ago. He had delayed graft function and so he had continued right along with his normal dialysis schedule. He had been on dialysis for 3 years.

Over the week-end, his kidney opened up (recovered renal function in his transplant kidney) and so we held his dialysis on Sunday (patients on the TTS schedule received the Saturday dialysis on Sunday due to a Thanksgiving schedule shift). Today his creatinine fell further and I told him he was done with dialysis.

He immediately began to cry and convulse. I wasn’t sure if these were tears of joy or a seizure. After a few minutes he was able to speak again and told me how happy and grateful he was to be off dialysis.

It was one of those moments the makes being a doctor special.

Sometimes the simplest things…

I just had a great patient encounter.

An 83 y.o. African American gentleman was referred to me for a creatinine of 1.7 mg/dL (eGFR 50 mL/min). On the initial visit he had a positive review of systems for obstruction. I added a PSA to my normal laboratory work-up of CKD and it ended up grossly positive at 42. We referred him on to urology and they diagnosed prostate Ca. He is currently getting hormone therapy.

Today he came in for his first visit with me since the cancer diagnosis. He was so appreciative. He hugged me. He acted like I saved his life. There was a strange asymmetry to the experience, I felt that I had done almost nothing more than a routine diagnosis while he was treating me like William Osler.

Sometimes the simplest things. . .