knocking the rust off

     I look at my text.  There's a patient in the ER who has Pick's Disease.  Pick's Disease is a form of dementia a bit like Alzheimer's except instead of memory loss being the major first symptom, they tend to have personality changes first.  What used to be a prim and proper little old lady will start cussing like a sailor and then not see that they've changed or done anything improper.  Like any dementia, it tends to be hardest on the family members and caregivers.  The spouse had reached their limits and could no longer protect the patient from their self so came to the ER.
     There was nothing I could for them medically.  But being a doctor is more than just being a drug monkey.  I did what their neurologist should've had the guts to do but didn't.  I started to have "the talk" with them.  What does the patient want from their last moments on this earth?  What does each of the family member want?  How can it be arranged that the patient is safe but their final wishes still be honored?  I didn't intend to complete the conversation then and there.  I just wanted to plant the seed and begin to allow the questions be pondered and pontificated over.  They still had time to do that.  But I told them they don't want to have that conversation when the patient gets admitted for pneumonia and the next thing you know, they're in the ICU and everyone is too stunned to know what to do next. 
     Before this June rotation, it had been a good 10 months before I had seen an adult patient.  There was a lot of rust to knock off.  And even then, there wasn't the rhythm and flow that I used to have for the first 9/10 of the rotation.  This patient was the first time I got back into that groove.  I heard their story beyond just the physical problems and connected with them.  The fact that it was on a terminal patient is not lost on me.