Lessons from the ER

Yesterday, I was amazed by two things: I admitted a 92 year old gentleman who came in with shortness of breath. After talking to him and his wife, getting a history and doing my physical exam, I concluded that his shortness of breath (SOB) was most likely due to his congestive heart failure: pulmonary edema due to left sided heart failure. During my physical exam, he didn't sound so bad. There were a few crackles and wheezes, but he wasn't sounding that bad. I presented the case to my attending, and we returned so that my attending could confirm what I found and give his assessment. Within....say, 30-45 minutes, the patient's condition had changed dramatically for the worse. His breathing was laboured, there were loud wheezes, his resp. rate was 34, and his oxygen saturation sats dropped to below 80% - all signs of respiratory distress. We diuresed him, gave him oxygen by mask and then started BIPAP (a breathing machine) to help improve ventilation, and within a few minutes, he started feeling better. Upon reflection, I am amazed at how quickly he decompensated - how he was stable when I saw him, but just a few minutes later, how bad he sounded. Makes me realize how important it is to keep a close eye on patients like this.
The more amazing lesson I learned, however, came from his wife. There she was at his bedside throughout the whole time. There she was holding his hand. There she was wiping sweat from his brow. There she was, encouraging him that things would be okay. And there she was, talking to me because he had difficulty with his words. Telling me that they had been married for 65 years, and through her actions, telling me that she would be loving him right to the end.