House Call

An 82-year-old retired nurse named Helen couldn't walk this morning. Her leg buckled when she stood and wouldn't snap back in like before. She shuffled from chair to exam table on the good leg and howled when I leaned on her shin. I could feel tibia scraping femur. I was a recent-mint city hospitalist filling in for a vacationing general internist in remote Montana, and to me Helen's story meant a knee brace, ibuprofen, and a next-day appointment with the local orthopedist. The twist was that Helen lived alone in a third-floor apartment. I pictured a dismal little room with a mothy smell, sparse furnishings, and shag carpet that would trip her up.

“How will you get upstairs?” I said.

“I ride the elevator,” she said confidently. She had combed her short silver hair straight down to the temples and wore gold-framed glasses. “Don't worry, I can get around.”

But she could hardly stand from a chair. I couldn't imagine how she would maneuver about the kitchen to fix a sandwich or push off the couch to hobble to the bathroom. She had been mobile and healthy her whole life, and I worried that she didn't appreciate the extent of her sudden disability. I suggested a wheelchair.

“You might have to,” said her friend Jan, herself a retired nurse. Jan had picked up Helen first thing that morning and driven her to the office.

“Or crutches,” I said. I wondered if Jan should stay with her, …