Choosing Geriatrics

We were riding in a cab to visit a patient's home on Madison Avenue. My colleague read the triage sheet. “He is an older guy with diabetes, renal disease, heart disease, recently signed out of the nursing home.” I thought how unusual it was for anyone to sign out of a nursing home. “He's been to the ER for chest pain, but signed himself out of there, too.” Our job this morning was to determine if the chest pain was serious enough to require his admission to the hospital.

The patient's close friend greeted us at the door of a large, sparsely decorated apartment with a bed on one side and the kitchen on the other. The room was clean, but not well-illuminated. There was a wheelchair next to the bed, and at its foot, a small television was showing a Spanish soap opera—a man was sweeping a woman up into his arms and proclaiming his love.

I spoke with the friend while my colleague talked to the patient. The friend was a woman in her late forties, with brown eyes, small build, and a matching sweater-pants ensemble. “I do not know what to do. I am not his family. His father and my father were very close amigos in Puerto Rico. He has a lot of kids but they are fighting. I have been visiting him every day but it's too much for me. The social worker promised us a 12-hour home attendant. Those people in the hospital always lie. I am tired and need to take care of my own problems.” She showed me prescriptions that hadn't been filled. “He doesn't want to get the prescriptions because they cost too much money.” She was worn down, but obviously wanted what was best for …