I settled my eighty-one-year-old Vietnamese patient in the chair, greeted him through the interpreter and rifled through his chart.
Over previous visits I had documented several alarming complaints and findings. The patient, today wearing a pink hand knit sweater and a royal blue toque topped with a massive pompom, looked cheerful, but he had anemia, eosinophilia, massive weight loss, a productive cough, abdominal pain and risk factors for PTSD. My differential was studded with heavyweight diagnoses, including cancer and tuberculosis, and I was navigating him through a series of investigations towards an explanation for his problems. We were honing in on an answer, and I was eager to press ahead.
Conscious that the patient's agenda sometimes differs from my own, I resisted launching into a review of the most recent test results and asked if there was anything specific that he wanted addressed that day.
He nodded vigorously, and excitedly relayed a question through the interpreter. She clarified several times with him, looked doubtful, and asked me, "He wants to know if he can ride a bike! He's been learning to ride one. His little grandchildren bike all over the neighbourhood and he wants to join them." She added in an anxious whisper, "What if he falls off?"
I gave him permission to ride a bike.
He's frail, and he might injure himself. But the elderly man with multiple medical red flags, the diagnostic puzzle, the query carcinoma, in real life is a grandfather who wants to pedal through the alleys with his grandkids after school. Who am I to deny him that?