I like little old ladies. I also have a particular fondness for the reminiscent stories of chatty old men. I don’t know what it is about old people, but they can always make me smile.

So, I shouldn’t have been surprised to find that the 75-year old woman in the ER with the fractured hip was able to make me laugh even through her pain. She was spry and wry and winked at me. We were an instant team against her drill sergeant daughter.

Mrs. LOL* was admitted to our service because she had fallen 6 times in the last month and had multiple comorbidities that complicated her care. One thing I love about Internal Medicine is that we get to keep the big picture in mind. Ortho was consulted for her hip surgery. Cardio was consulted for her chronic congestive heart failure and atrial fibrillation. Pulmonology was consulted for her COPD. And we sort of kept track of everything.

She went for surgery and they fixed her hip. We scanned her head to look for remaining signs of a recent subdural hemorrhage. Finding nothing, we went ahead and gave her prophylaxis anti-coagulation for her deep vein thrombosis (DVT) risk. Physical therapy came in and got her out of bed. Cardio watched her afib on telemetry.

Mrs. LOL was stable and even improving. The only time I saw her grumble or close her eyes and pretend to be sleeping was when physical therapy came by. She would still peek out from under one eyelid and smile at me if I came in the room. Her family snuck in milkshakes from Braum’s and tried to bend the rules of the “healthy heart” diet she was on. There were a couple of confusing conversations about imaginary tea parties and babies, but Mrs. LOL was doing great post-operatively and would be shipped to rehab shortly.

The other morning I walked into her room and was shocked at what I saw. Mrs. LOL was restrained to her bed for pulling out her foley and wrapping her arms up in the IV lines. She was distraught and delirious and appeared to be in the middle of a horrible nightmare. I sat with her most of the morning as the nurses, intern and I sorted out meds and oxygen and anything else that might have changed her mental status overnight. Her family came and stayed with her in shifts.

Mrs. LOL was in the midst of an acute exacerbation of her systolic heart failure. Her heart wasn’t pumping like it should. Fluid was backing up into her lungs. She sounded like she was swimming when she breathed. The colour had drained from her face and her lips turned blue. We gave her furosemide by IV and mouth. We watched the lungs clear up and her mental status return.

She has been on three different floors since she arrived. Last night she was moved to a more acute floor with better monitoring and more nurses. I had a hard time leaving today. I’m not sure if she’ll still be there when I get back on Monday.

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*Little Old Lady: As in “House of God” by Samuel Shem, but with sincere adoration.

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