Tales of Survival: The 16W Grandpa

October 9, 2008

bellevue.jpgWelcome to “Tales of Survival,” a new feature of Clinical Correlations.  Bellevue Hospital, the nation’s oldest public hospital and the heart of our residency program, provides unique and unforgettable training for new physicians.  It is probably safe to say that every resident who trains at Bellevue graduates with a lifetime of stories about the experience. “Tales of Survival” was created to convey some of those experiences.

Written by Sherley Abraham MD, PGY-3 and Parul Gandhi MD, PGY-3

Beepers beeping and sign-outs shuffling, another day begins on the Bellevue wards. A ruddy faced man half draped in a gown walks down the hall asking for a doctor and gesturing with his urinal. A medical student quietly recites his presentation, proceeding through a twenty point checklist of physical exam. And I sit, clicking through vitals and labs, with that pit in my stomach because we are on long call, and who knows what luck and the ER have in store for the 16W1 team.

All this time, Mr. N, my elderly Chinese patient stands in the corner, arms folded behind his back, shirt tucked in his trousers, and hospital gown worn as an overcoat. His long gray brows do not stir as the ruddy-faced man becomes irate, not minding that he is pant-less. Mr. N has become accustomed to the 16th floor of Bellevue hospital, getting his bearings faster than an intern.

Mr. N was more than our patient; he was part of our team, part of our family. We even called him the 16 West Grandpa. As we assembled daily, everyone gave a hello to Mr. N and he looked back stoically, with an all-knowing wisdom. The problem was that he didn’t know where he was. He didn’t know how he got here. He was brought into the hospital after he was found sleeping in a gas station forty-five days ago. He came with the outfit he wore now, money in his pocket, a set of keys attached to his belt loop, but no ID and little recollection. We worked him up for dementia and tried to engage him in his past, searching for a clue that would allow us to answer the most pressing question in his care: who is he?

I thought to myself, “Why hasn’t anyone claimed him?” He had already endeared himself to our entire team. Maybe he was telling us some version of the truth. Through Toishan to English interpretation, he gave us a story of traveling to the U.S. from China on a bus for $1. He told us his family lived in China. When we pressed him for details, such as where the keys he wore opened to, he answered nonchalantly, “a door.”

In the meantime, every morning he would offer an arm in phlebotomy or a piece of fruit from the collection he had arranged on his bedside table. In the halls, he would offer seeming acknowledgement as we passed him. We began treatment for multi-infarct dementia and reluctantly placed him on a long waiting list to travel across the East River to a nursing home.

Day after day we tried to gain additional information. We added a rhetorical “Who is Mr. N?” to our sign-out task list. Due to a shortage in Toishan-speaking interpreters at AT&T, we asked for another social worker to join us one day and interpret during rounds. He translated and stared at Mr. N, perhaps because of his all-knowing yet unknowing look.

The next morning I was seeing a new patient in ER, at the time of day when it is eerily near empty. I received a page from my social worker, which was also strange for that time of day. “The mystery is solved! I know who Mr. N is!”

He was actually Mr. W. The social worker who translated the day before remembered working with him fifteen years ago in a restaurant! He was known as Grandpa there as well. The social worker called the restaurant and luckily, Mr. W’s son-in-law was still working there. It turns out his family had been looking for him under this different name. And better yet, they were coming to pick him up later that day.

I was so excited and announced the reunion to everyone who knew the 16 West Grandpa. As his daughter arrived to the ward, her first words were nervous, almost crying, almost laughing. Mr. W looked on, his expression making the meeting as mundane as daily rounds. He packed up his fruit and ambled off the ward quietly, within the clamor of his relieved family, our team in the background, waving him goodbye.

Our experiences as Bellevue residents teach us to be better clinicians, but every so often, they also renew our faith.