I’ve been working for over five years in home-based primary care division of geriatrics. As a physician assistant (PA), I don’t have to stay in one specialty for my whole career. Many PA friends from graduate school have transitioned between fields: cardiology, bone marrow transplant, neuro ICU, critical care, OB-GYN, dermatology, oncology, and so on. Why haven’t I switched to something more glamorous or exciting? The answer is almost impossible to capture in words, but I’ll give it a try…
When I walk into someone’s home and look around, I know more about them in a few minutes than an hour of clinic time can tell me. The invitation to keep coming month after month and be the go-to person for an older adult who has trouble making it into clinic is a holy privilege. Here’s an example . . .
A patient, who just happened to be a former professional athlete, was referred to us after he developed severe heart failure. And then, while he was under our care, he developed metastatic prostate cancer. Right after the lymph node biopsy that diagnosed that cancer, his heart rate plummeted to the thirties. The inpatient cardiology team showed up at his bedside ready to put in a pacemaker, but he refused. “I know my body, and my heart rate is low. I’m an athlete. I think it was the anesthesia.”
The hospital team was understandably frustrated, but he turned out to be right. His heart rate went back up to baseline. When I saw him back at home, he told me he didn’t appreciate the way they rushed him to a decision. My first thought was that a heart rate that low is an emergency, so the rush made sense. But sitting with him relaxed in his own home, I also understood why he wanted someone to sit with him and explain all the risks and benefits. I explained why the pacemaker would lower his risk of a heart attack. I referred him to arrhythmia clinic, and he ended up getting one.
He passed away a few weeks ago. I cried as though I hadn’t experienced death as much as I have. He was special.
Feeling at home is what allows our patients to fully express how special they are.
Sara Lynne Wright
Mountain View, California