I had a man come into the ER one day. He was 94 years old. He had had diarrhea for two days, and then that morning he had felt tired and drowsy. So much so that he didn’t go out to walk his sheep to pasture and watch them all day, as he had done every day for nearly a century, with hardly any breaks. His daughter had gotten nervous and brought him into the ER. He spoke very little English, but he told his story with no frills and no fuss. It was not a big deal to him. His daughter supplied the nervousness. We drew some blood to check for all the usual suspects, i.e. infection, diabetes, anemia, etc. We hooked him up to a line of normal saline because we figured after two days of diarrhea he would be a bit dehydrated. Then we got a 12 lead EKG, which showed a rhythm that many 50 year olds would envy.
You have to picture him as I saw him, to understand. He was old, with a typical broad, Navajo face burned almost coffee brown from years of weather. He was very tall. I would bet he was once over six feet, and even now he stood with very little stoop and was as tall as I was. He wore tight jeans and cowboy boots, and a belt with an enormous buckle, a flannel button up shirt and a white cowboy hat. All his clothes were well worn, but clean, as if he had gotten dressed up to come to the hospital. When I went to look for a vein to stick him with the IV I saw that his arms were still thick and ropy, with great, gnarly veins like worms coursing under splotchy brown skin. He had the same perpetual farmer’s tan my Dad and Grandfather always had. He sat bolt upright on the end of the bed, kicking his legs like an impatient two year old, until we asked him to slide back against the raised head of the bed. He hopped his feet up onto the end of the bed and scooted on back with ease and when I asked him, through his daughter as an interpreter, whether that had made him tired, he took a deep, exaggerated breath and shook his head with studied nonchalance. “No.”
Bless his heart, that old man wasn’t giving us an inch. I rejoiced to see his pride.
So I got his history and did a physical exam. I had a hard time listening to his lungs through the thick, solid muscles of his back. His daughter said he used to be a very powerful man when he was younger. All I can say is, if I make it to ninety, may I be in that kind of shape. He told us a bit about his experiences as an artillery man in Europe in WWII, and seemed to be much more interested in that story than in being too tired to walk the sheep for one day.
We left him with a specimen cup and instructions to give us a urine specimen as soon as he could. I wanted to check for a UTI (Urinary Tract Infection). It’s always in the back of your mind for old people with unexplained sudden general malaise. But then again, so is pneumonia, G.I. bleed, septicemia, etc. You have to rule out problems by system, there are so many possible issues.
Over the next couple of ours the labs were backed up with patients and so were we, but the old Shepherd’s results came in a little at a time. I checked in on him from time to time. I listened to his lungs to make sure the fluid we were giving him intravenously didn’t go to his lungs. It can do that with old people if their kidneys aren’t working well. After a couple of hours all the blood was back, but he still hadn’t given us any urine. He kept insisting he couldn’t go, which made me suspect he was even more dehydrated than we thought, although these desert folks are probably always down a percent or two from what textbooks would consider optimum. One time I checked on him, he was sitting in the bed twiddling his thumbs (literally) with a frustrated look on his face, and he asked if he could go yet. We told him we couldn’t let him go until we checked the urine. He sighed and looked at the urinal, and then asked us and his daughter to leave. Five minutes later the specimen was at lab.
It turned out nothing was wrong with him. EKG, Chest X-ray, CBC, CMP and UA all negative. All his numbers were probably almost as good as mine. He probably just got a viral gastroenteritis and was feeling sluggish simply because of the dehydration. We let the nurses give him a sandwich and some juice and tell him he could go as soon as he wanted. He ate the sandwich, put his shirt and hat back on and left with his wide, hip swinging stumping walk in those old, beat up, carefully cleaned cowboy boots.
I loved that old man. He was a man with true greatness of soul. He had found something that he loved, that brought him peace, and he was going to do it, and keep doing it. Never mind that his life was slowly drawing to a close. The sheep still needed to go out to pasture every day. He still chose to spend every day alone out in the open air and sun of the Arizona desert, still ate the traditional diet of mutton and fry-bread, still lived and kept close to his children. Someday I think they will find him lying alone and still out on the mesa, and I envy him that death. That is a life truly lived, lived so well that not even the growing onset of death can interfere with him in his business of living his life.
That is true greatness of soul.