Tuesday, April 10, 2012


    I have seen many patients , that want to live, in spite of 'bad ' diagnosis, and poor prognosis. But this one was unusual .
    Susan was my patient  for long time . She had advanced  chronic obstructive lung disease. She was on oxygen 24/7 . At most could walk 30 to 50 feet. And she was admitted with abdominal pain . Further work up with the scan etc showed that she had acute gall bladder attack . We had no choice but to do the surgery . In those days there was no option of "small incision "i.e. lap choly. surgery . So we had high risk of being on respirator post operatively. As expected she was on respirator, and it became very difficult to wean her off . After 12 dyes we had to do 'trachostomy' . We continued to wean her off , we were doing not too badly , but she was quite scared and was dependent on the respirator and almost addicted. When we would cut down the support from the respirator, she continued to do well . But once we told her about the cutting of the support or that she was on her own , she would get panicky .So I decided to do a trick . I continued the respirator , but there was no support from it . After 2 days ,I told her that she was not on the respirator support, but breathing on her own , she got mad , and anxious , but was latter on happy . I did discharge her home with the tracheotomy.
  I saw her in the office in couple of weeks. She was short of breath, but had learned  to 'talk' with the trach. She was in a wheel chair , but she and her husband were happy to to be home. At the end of the follow up she talked to me and made me promise that I would never ' put her through ' the respirator etc . I had to ask her , " Susan if it means you will die , do you still want to be  not on respirator ?" The answer was firm 'yes ' and the husband agreed .
   I was suppose to go go out of country on vacation. My flight was at 8 pm. I was still going to make rounds in the hospital and then hand over to the 'covering ' physician at  1or 2 pm , get ready and go . At 6 am I got a call from the emergency room . Susan was in Emergency Room and was short of breath. I saw her , she was not bad but was short of breath. I talked to her and her husband. We decided to  admit her in Intensive care unit. Did some orders. She did not want to be on respirator. I told her that I was going to be out of town for next 3 weeks. After I finished my hospital rounds I went back to the Intensive care unit and saw her . she was little better. Still quite short of breath, but still with 'progam '. , knew what was going on . Her husband was in the room . She stretched her hand and I held it . Her other hand was held by her husband. She put her finger on the trach, and tried to talk . Her voice was very low. So I had to put my ear very close to her . She said in low but firm voice/tone ,"Doc , Please , please let me die , Do something, so I will die , before You go out of the country. I don't trust anybody but you . " I had already written orders for the comfort and told the covering physician . So I 'promised ' her that she will not be on any 'life support' .
      My flight was at 8 pm . I was to board at 7 pm as it was international flight . I called the ICU and spoke to the nurse taking care of Susan .

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