Presentation
William Toms
The patient is a 61 yo M with a Hx of NIDDM, ASCAD, HBP, COPD and CHF who presents with chest pain radiating to his jaw and both arms for thirty minutes, accompanied by diaphoresis, SOB and nausea. PE shows bibasilar rales, generally regular rhythm with frequent ectopy, an S3 gallop, 2+ JVD, liver edge 10 cm below RCM, 2+ edema. EKG shows Q’s V 1-4, STE V 3-6; CXR shows cardiomegaly and basilar congestion. Initial CPK and troponins are elevated…
and his wife is in the waiting roomterrified
and his children are on the wayworried
and his dog is at homeconfused
and his flowers are in their bedsgrowing
and, yes, he has a Living Will
and, yes, he would like a tissue
to wipe away his tears
About the poet:
Bill Toms was medical director at Dartmouth-Hitchcock Keene, a large group practice, for nine years, retiring in 2005. He now practices part-time, seeing homebound patients for his colleagues, and leads discussions regarding listening to patients at Dartmouth Medical School. “I have been fortunate to have been a family physician in » Continue Reading.