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Attending on General Medicine

As is my usual pattern, this December I am attending on a general internal medicine unit rather than my usual geriatric service.  Usually there is scant difference in the age distributions of the two services, but this year our general medical service has admitted mostly young or very young patients.  I use the standard definitions of young and very young:  very young means younger than me, young means less than 10 years older than me (note:  my oldest son disputes these definitions and even has the nerve to call me old!).

We have admitted several young people with inflammatory bowel disease (common as Mount Sinai is a magnet for people with IBD), but the scariest issues have been obstetrical and gynaecological.  We admitted a 40 year old woman with obstructive renal failure, who has a small child and who was a childhood victim of severe sexual abuse.  She turns out to have widespread cervical cancer, clearly inoperable.  A 37 year old woman, a breast cancer survivor, was admitted with an end stage sarcoma, but she was pregnant!  Her most heartfelt wish, that she survives long enough to have a healthy baby, is almost certainly unreachable.  Another pregnant young woman was admitted with a movement disorder, likely a conversion reaction.  And people feel that geriatrics is depressing!  It is one thing to face death in your 80’s or 90’s, another when you are in your 30’s.  One of our patients is a 97 year old man who presented with obstructive renal failure secondary to previously unknown metastatic prostate cancer.  He and his family are at peace with the diagnosis, and understand the palliative nature of our therapy.  Needless to say, I find the death of a 37 year old pregnant woman more distressing than that of a 97 year old man who has lived a full and wonderful life.

Best wishes to everybody for the holiday season, and enjoy this exciting new medical resource.

Barry Goldlist
December 13, 2010