Making assumptions

My friends Stephen and Alison have an elderly cat named Truffle. Truffle is 18 and a half, a Methuselah in cat years, and blind as a bat. Not too long ago Truffle started peeing in the kitchen. Someone would go down for breakfast in the morning or arrive home at the end of the day and find a puddle in the kitchen. The inescapable conclusion was that because of her advanced age Truffle was becoming disoriented in addition to being blind, and could no longer find the litter box.

Wrong. What Truffle was desperately signaling by peeing the kitchen was that she had a bladder infection. Because everyone came to the wrong conclusion, the problem was only flagged when she stopped peeing altogether and needed emergency veterinary care.

The same kinds of assumptions are made about elderly humans. Since there is an expectation that their health, mental acuity and quality of life will invariably decline before they die, solutions to their problems are often missed. It could be that the culprit behind their confusion or poor balance or forgetfulness is their medication or their insufficient diet, but that is often not investigated, even though a small tweak in dosage, a different medicine, or some supplements and fresh fruits and vegetables could make all the difference.

Illnesses are treated the same. It is assumed that once you have an illness, especially one decreed to be fatal, all your pain and discomfort can be attributed to it. Several years ago some colleagues and I treated a pancreatic cancer patient who responded with an astonishing turn-around from being on his deathbed to reversing his jaundice and being released from the hospital. Even though he went home to receive outpatient care and continued to improve (being able to get out of bed, walk around the house, go up and down the stairs, walk to the park, go grocery shopping, spend weekends at the cottage) the expectation was that he would eventually decline and die. Because of this expectation, his multitude of healthcare providers all missed the clues of the impending septicemia which in the end killed him.

A friend of mine who is an MD tells an interesting story from his days as a resident. He was on his neurology rotation and he was asked to go down to admitting and take a history on a woman who was about to be admitted to the neurology department because she kept falling down. When he got to the waiting room, my friend found a very large woman sitting in a chair holding her hugely swollen knee. After she complained to him that her knee was giving out on her and causing her to fall, it didn't take him long to discover that she had a torn ligament. My friend then logically sent her to orthopedics and got into big trouble with his supervisor for not playing along with the assumption that her problem was neurological.

It can take some powerful advocacy to get the right kind of care for the right condition in the face of mistaken assumptions.