Tuesday, October 27, 2015
Gone to Carolina
“Can't you see the sunshine?
Can't you just feel the moonshine?
Ain't it just like a friend of mine to hit you from behind?
Yes, I'm gone to Carolina in my mind.”
For 13 days straight, I've asked the same questions. “Where are we this morning? Do you know where you are?”
Most days, it's something vanilla like, “We are right here.” You point down at the sheets on the bed. “Right, right, here.” You look up at me hopeful. And on some days fretful.
“Where is here?” I press.
“Right over here. Not yonder, but here.”
Which is technically true. But false at the same time.
Is this delirium or dementia? Or is it both of them stacked on top of one another? Your mental distance is yonder. It saddens me so I keep trying and asking the same questions over and over again. Hoping I'm wrong.
Your family says that you're pretty much “back to how you normally are.” And at an age too young to even qualify for Medicare, I wish they were all wrong. So I keep asking.
As of this morning, you were better with regards to what had you hospitalized. Your heart failure exacerbation had improved. The swelling in your legs had dissipated and the oxygen requirement caused by the fluid filling your lungs had waned. From a medical perspective, you could return home. And even though I'd already told your loving family, I still felt the need to tell you, too.
And so I did. You just looked through me with a vacant stare, smoothed out the covers, and sighed. A little hopeful but mostly fretful. I didn't really know what to do with that so I returned to the basics.
“Where are we this morning? Do you know where we are?”
“Oh. We here. We right, right here.”
I rubbed your cheek with my hand and smiled. “Where is here?”
This time you smiled back. “Greensboro, North Carolina.”
My eyebrows raise. This was new, on the last day no less. I'd never heard you say that answer before. Instead of following it up with my standard, “We are at Grady Hospital in Atlanta, Georgia,” I left it be. Because this time your eyes were dancing and your expression was so sweet, so innocent.
And, for once, not vacant. Or fretful.
I'd later learn from your daughter that this was where you'd been raised. Milking cows and running through fields with your siblings. The simplest time of your life had been there. Right, right there.
And so. Upon your discharge I left you there. And for the first time since you'd been hospitalized, some piece of me found solace in knowing that you were there. Gone to Carolina in your mind. Instead of here. Right, right here.
Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.
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