Surprise!

A birthday party for an elderly patient takes a surprising turn.


I have always loved surprise parties. When I was a freshman in college, I wrote “Newman Surprise Party” on everyone's calendar in my dorm and promptly forgot about it. Months later, when my birthday came, they threw me a party, and I was surprised! It became a family tradition. My mother threw me a 50th surprise party, when I was 48 and it wasn't my birthday. And to cap off this trifecta of unexpected celebrations, I threw myself a surprise 60th birthday party this past April. So it should come as no surprise that I wanted to throw a party for Gladys Johnson.

Illustration by David Rosenman
Illustration by David Rosenman

Gladys (as she insisted we call her) was initially admitted with pneumonia. She had the shortest medical history I had ever taken on a geriatrics patient. She was 99 years old, lived independently, and her only medication was glaucoma drops. I planned a short observation stay. When I told her this, her only response was that she was a tricky patient and we shouldn't count our chickens before they hatched. Then she graced me with her beautiful smile.

Her influenza swab was negative, and I started oral antibiotics the next morning. I was hoping for a rapid discharge, but she developed acute nausea and began to throw up her lunch. This continued until the nurse called me to say her emesis had turned bloody. I ran to her room. She lay there, somewhat hypotensive and pale. But still she smiled and reminded me she was a tricky patient.

One complication followed another, culminating with a fall and humerus fracture. It was her 37th hospital day and I was back on service. She remembered my name and other details with crystal clarity. The staff all loved taking care of her but were saddened that she never had visitors. She told us all about her six children (four daughters and two sons), 14 grandchildren, and 27 great-grandchildren who lived around the globe, none of them nearby. She never wanted us to call anyone with updates, but she called her family frequently.

Her renal function had been deteriorating, and she was quite clear that she would never start dialysis. She assured us that we would find a way to keep her kidneys working, once again reminding us that she was a tricky patient. I consulted nephrology, checked her urine and renal ultrasound, and avoided nephrotoxic drugs. We did the whole mighty workup with no obvious cause of her problems identified. As usual, her response was that she was a tricky patient. Finally she agreed that if things got worse, I could call her eldest granddaughter, a physician in Berne, Switzerland.

It was my last day on service for a week and I was reviewing her chart again. I decided that I needed to call her granddaughter and fill her in on the details. I also noted the very important detail that her 100th birthday was a mere 10 days away.

I reached her granddaughter, Dr. Sophis. She was shocked to hear about her grandmother but said she appreciated our efforts on her behalf. I had a sudden inspiration and decided to mention Gladys' upcoming 100th birthday. Her granddaughter gasped when she realized she had forgotten. I then told her my great idea: How about a surprise party? Dr. Sophis readily agreed and promised to call all the relatives and all their families. I got her email address, and over the next few days we made our secret plans.

I reserved the biggest conference room in the hospital. The whole family would wait there. I would have PT get Gladys up in a wheelchair, and I'd offer to take her for a stroll. And we'd wheel into the room for a fantastic surprise. I kept it as secret as possible. I didn't want a loose-lipped colleague spilling the beans.

The special day arrived and the family was installed in place. Gladys had her hair done nicely, a nurse who was in on the plan had done her makeup “just for fun,” and she wore a lovely cashmere sweater. We rolled into the room and the lights flipped on. Everyone yelled, “Surprise!” But Gladys said nothing, and the room fell quiet. “This is nice,” Gladys remarked, “but who are all these people?”

I looked at the doctor who had flown in from Switzerland, and all the daughters, sons, grandchildren, great-grandchildren, nieces, and nephews. Dr. Sophis stepped forward and said that this was not her grandmother at all. I had contacted the wrong family.

The room was deadly silent. The seconds ticked by and I could feel the sweat pour down my forehead. I had told the wrong family her medical history and brought them from around the world, at great expense and time, to see the wrong patient. My pulse raced.

Then I looked at Gladys and she was smiling ever so slightly. From the back of the room I heard a chuckle, then the whole room broke out in raucous laughter. They all rushed forward and began to hug Gladys. She smiled at me, enjoying my severe confusion.

“I heard about the party from my big-mouthed grandnephew Morris,” she laughed, pointing at the one who had clued her in. “So I told them all to pretend they did not know me. After all, I told you I was a tricky patient!”