Saturday, March 17, 2012


  I am not sure what constitutes an emergency. I had read it somewhere . that. "inadequate planning on your part does not constitute emergency on our part . " So in my office sometimes when   my office staff tells me about someone , who  'has to be seen , because of the emergency,'   'I want  to know  what exactly is the problem.
   It was Monday. The Mondays are very busy. So when I entered thee room and saw John , I was surprised, as I had seen him less than 10 days ago . He was my new patient. 65 years old male with history of smoking one pack  of cigarette a day, now with shortness of breath, and cough. My impression was COPD -chronic obstructive pulmonary disease, damage to the lungs that accrues with smoking. We advice him to stop smoking, offered him various options, to help cope with symptoms that would occur with quiting smoking and arranged to do breathing test. This is to  check on amount of lung damage that occurred with smoking. This was done next day and we called him to let him know the results. He had lost almost 40 %.We started him on medicines and again told him to quite smoking. He was set for the follow in 6 weeks.
    So I was not sure as to why he was seeing me so soon. I took chart and went out of my room . It was 3-45pm , and I was seeing the patient scheduled at 3 pm , so I was not very happy . I asked my office secretory as to why he was here. She had simple answer, " he said it was emergency. "I went back in the room  and asked him why he was back so soon . I said , " As I understand it is emergency, ". He said  , ' Doc, I can't smoke . ' I was not sure what he meant by I can't smoke , and how that was an emergency. His answer was not much clearer. He said , ' since I saw you , I had tried to cut down on smoking, . But now when I tried to smoke I can't smoke . ' " what do you mean you can't  'smoke' , I asked .He answered , ' I can not inhale . When I tried to inhale it does not go in my lungs . '
     I was still not sure what does this mean, but I decided to check him out . I listened to his lungs , they had some wheezes . I asked him to open his mouth and looked inside , and I saw the answer to his question and the problem .
   He had a perforation in the hard palate , so when he would  try  to smoke the smoke would leak through the hole and not much could get in the lungs, hence his statement , his feeling that he could not smoke.
    I referred him to ENT, throat specialist, had biopsy and the diagnosis of cancer.
   I still can't understand how not being in position to smoke is an emergency.

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