Dr. Poppins

It was another glorious week on the inpatient geriatric medicine consult service at St. Mary's Hospital in Rochester, Minn. Our team included yours truly, Jamie Newman, as attending; Dr. Shu, a geriatrics fellow; and Dr. Ivare, a second-year internal medicine resident.

Dr. Ivare had just presented on a consult we had received to assist with medication optimization for a delightful 95-year-old woman, whom we'll call Ms. Peggy. She had a history of type 2 diabetes, hypertension, and osteoporosis and was admitted for an elective procedure. Dr. Ivare reviewed all the reasons to continue her denosumab injections for her osteoporosis, especially the disadvantages of abruptly discontinuing or missing a dose. Dr. Shu pointed out that a recent increase in her amlodipine dosage could be contributing to her worsened lower-extremity edema. It was also noted that she had some episodes of hypoglycemia, requiring “a spoonful of sugar” and insulin adjustment.

After the clinical conversation was complete, Dr. Ivare (who has a predilection for exploration) ecstatically pointed out that Ms. Peggy's room looked out onto the hospital's rooftop patio. He explained that he had always dreamed of finding and visiting this patio. Amused, I promised that I would take both of my colleagues there. I suggested that we meet in the afternoon in my office, and Dr. Shu added a plan to wave to Ms. Peggy. It was decided that Ms. Peggy and her daughter would look outside towards the rooftop patio at 2:30 p.m. After all, “in every job that must be done, there is an element of fun.”

By the appointed time, Dr. Shu had hand-written a sign reading “Hi Ms. Peggy!” and we three ascended the stairs to Old Marian Hall, which just happens to house both my office and the secret entrance to the magical patio. At first, the door seemed to be locked, but it miraculously opened, granting access. “Up to the highest height!”

On a nice day, it would be a great place to “go fly a kite.” Unfortunately, at the time of our visit, it was raining. However, Dr. Ivare, in full expedition mode, had come prepared with his personal umbrella. He was determined not to miss what he called “the opportunity of his lifetime.”

Out he danced onto the patio in the pouring rain, holding up the sign to greet sweet Ms. Peggy. It was a picture-perfect moment, as you can see. He was realizing his ultimate dream of stepping onto the “secret” patio, and also making a thoughtful gesture to a patient to break the monotony of a hospital stay. “Sometimes a little thing can be quite important.”

The windows were too tinted for us to tell if Ms. Peggy was watching. Dr. Shu and Dr. Ivare went back to her room afterwards to see whether she had received her balcony salutation. Alas, she had forgotten and was instead enjoying a cup of fruit while watching the Olympic swimming finals. When shown a picture of Dr. Ivare's rooftop escapades in the rain with his umbrella, Ms. Peggy chuckled and exclaimed, “He looks like Mary Poppins!”

The following day during rounds, Ms. Peggy's daughter apologized and explained that she had missed the balcony extravaganza due to an unexpected meeting. She was delighted to be able to receive the photographic documentation by touching her phone to one of ours. She had never done that before. It was “a bit o’ magic!”

I asked Ms. Peggy if she felt Dr. Ivare had done a good job managing her care. She gave a long and thoughtful pause. Her face turned very serious. Dr. Ivare was likely on his way to having palpitations and feeling beads of sweat on his brow when finally Ms. Peggy let out a cheeky grin and said, “Very good … I suppose.”

It's hard to choose a single word to describe this magical patient encounter, but all things considered, I think that word would be supercalifragilisticexpialidocious.