Dr. Moore, one of my nephrologist partners, was giving his on call report during our morning rounds. His night had been extra busy because of the hospital admission of Ma Caldwell, a 98 year old patient of our clinic. In my eight years of work at the clinic I had heard a lot about the Ma legend, but she had never required admission to the hospital. This morning Dr. Moore reported that she had presented to the emergency room about 10 pm with severe pain emanating from her upper back and anterior chest. Her complaints stimulated a flurry of activity to rule out a ruptured or dissecting Aortic aneurysm. This was ruled out and at 2 am she was settled in the critical care unit for evaluation of probable cardiac pain and possible acute MI.
After this report my other partner, Dr. Starling, elaborated that in the 20 years he had followed Ma she had developed significant osteoporosis. He suggested that some of her pain might be related to worsening of her back disease or even an acute compression fracture. He added that in the past month she had seen a local orthopedist and had been given a steel-ribbed back brace and he believed that she had had more back pain while trying to wear the brace. He said he would see her in the hospital, but he suspected that osteoporosis might be etiology of her pain.
Shortly after rounds Dr. Starling and I walked up to the hospital to begin morning rounds. As I walked through the critical care unit to see another patient I caught a glimpse of a sleeping Ma Caldwell. I stopped by her door and watched her peaceful, easy breathing. At least for the moment she was free from her distress.
At lunch I returned to the clinic and upon sitting down at the lunch table I found myself surrounded by Ma friends discussing her current illness. Three or four of her devotees had visited her during the morning and reported that although she was quiet when given pain medicine, within two or three hours she would sit up in bed and cry out with intense pain. They rehashed the past several months of Ma’s life including the weddings, funerals, parties and church gatherings to which various ones of them had transported her. By all accounts she had been chipper and had eaten well on all occasions. They noted that she had been preparing for the upcoming baseball season when she would perch for hours eight inches from the TV screen to watch the play by play despite her near total blindness.
“Well,” I interjected into this litany, “Dr. Starling says that she has been quite uncomfortable since the orthopedist prescribed the back brace for her.”
“Oh, not at all,” Joy, Ma’s neighbor and life long friend, replied.
“The back brace has not been a problem. Ma has worn it everyday. The real problem is that she is in agony because she can’t work in her flowers. She had a recent appointment with her orthopedist and he said absolutely not, she could not plant her flowers this year.”
So much for our clinical diagnoses of aneurysms and myocardial infarctions, osteoporosis and compression fractures. For Ma this was not a disease of the body, but a sorrow of her soul. The answer could not be found on her EKG, but from the observations of her companions. She lay in agony from not being able to work in her flowers. It is an uncommon diagnosis, but when you’re 98 it may mean life or death.