The stool sample

One of my 70-something year old patients had an appointment with me. As mostly happens, she came with her husband. As I walked into the room, he looked at me seriously and said, "Doc, I brought in a stool sample." My forehead creased as I tried to figure out what was going to come next. One of the things with being a doctor who sees entire families is that often, you get to address the health concerns of a family member that was only accompanying the family member you are actually scheduled to see. No problem. It comes with the territory. My mind was racing with differential diagnosis: gastroenteritis? Blood in the stool? Diarrhea? Colitis?

And then he handed me the bottle. I didn't get it at first, until I opened the bottle and emptied out the 'sample':

Falling...

An 80-something was escorted into the room by his wife and son. He was full of jokes.

"Doc! I have something for you!"

"Okay..." I say not knowing what to expect.

"If you fart in church, you'll have to sit in your own pew!"

He breaks out in a mischievous smile as we all laugh.

And then we get down to business. I had seen him before for a complaint of frequent falls. In his 80s, I suspected a gait disturbance, orthostatic hypotension, arthritis, a large prostate (necessitating him having to get up at the odd hours of the night to urinate). I had tried to address each of these, but his symptoms persisted. What was going on?

The falls were getting worse. I had him stand in the room with outstretched hands and his eyes closed, prepared to catch him if he fell. He was to stand that way for 30 seconds. Within 10 seconds he began to sway and fall. I caught him. The test was positive. This test is called the Romberg test and we use it to assess cerebellar function. A chill ran down my spine when the thought came to mind as to what this might be.

I needed an MRI of his head to be sure. I got the study and here is the result below:

The bright white spot in the cerebellum is a cancerous mass. We admitted him to the hospital. Over the next few days in the hospital, he became more confused, sometimes agitated and sometimes somnulent. His wife sat by his side and knit to pass the time.

We discharged him from the hospital to home hospice, anticipating that he would die within months. I fought back the tears as his wife placed 2 little cup mats she had knitted in the hospital into my hands and said,

"Thank you for everything you've done, Doctor. I want you to have these so that you'll remember us."

I am this patient's hospice doctor. I do not think I will ever forget him or his family. The mats are in my office.

Addendum on December 5, 2011....

While out of the country, I received news that this patient died this weekend.