Friday, April 6, 2012


    This one incident happened sometimes ago , may be a year ago , and reminded me of the above saying, " your eyes don't see what your mind does not think " . Let me explain.
    It was Saturday. Time was noonish . I was done with my 80% of the hospital round. So going home by 1pm to 1-30 pm was still possible. (which meant I will not be eating my Saturday 'lunch ' at 4 pm. )So I was happy. And then I got paged . The call came from one of my patient's son. 'Doc , Did you not see my father ?' I was not sure , who was he talking about . So I had to ask . his father was admitted to hospital last night , when he fell down . He was 844 years old patient of mine , who had been a heavy smoker . He had bad Chronic obstructive lung disease. and though was quite limited in physical activity , he was doing well. He was on oxygen . He had bad balance and fell down . So the son brought him to the hospital. He was admitted , after all different ct cans were done. No major injuries were noted on the CT scan   of the chest , brain or the belly. He was on regular medical floor , complained of pain , got pain meds and then had respiratory arrest. (or cardiac arrest ). So then he was put on respirator, (breathing machine). The admitting doctor saw patient for the short time and ordered him to be transferred ti Intensive Care Unit and  other lung/Intensive care specialist. Now the son was calling me to know what was happening .
    The other doctor saw him and dictated the note . It stated he saw patient for 90 minutes . The patient wa put on respirator by the respiratory therapist . This doctor put in a central line , which caused lung collapse, so a chest tube was inserted to expand the lung. In between this time his blood count had dropped and his blood pressure also dropped . The note stated all this with each diagnosis , after which statement stating that cause for each , e.g. low blood pressure , cause not known , drop in blood count , cause not clear , respiratory failure , cause not clear, etc . I told the son that I have to be officially called in on the consult to see  patient , as otherwise I can not see patient and told him to call the hospital doctor and tell him to call me . I was called to see him officially in next 5 minutes and I saw him  in Intensive care unit . I had known him from before ,and the son had told me the story, and Had seen the notes . So it took me less than 10-15 minutes to examine him and talk to the nurse.
     I called the son , after I put a call to the chest surgeon . I told the son , that his father broke ribs , when he fell down and had bleeding inside the chest, which in turn caused drop in his blood count and drop in his blood pressure and in this elderly  patient  , he had respiratory failure.The son was medically knowledgeable, and asked me . " the how come hi ct scan was normal ? " My answer was , I know what happened, and I don't care what CT scan showed . it is possible that it was 'too early '   yesterday to pick up this bleeding yesterday. I was ordering new x-ray and calling a chest surgeon as he will need surgery "
    As I expected the new x-ray showed the 'fluid' with rib fractures and I had to transfuse him 8 units of the blood. After we stabilised the patient the surgeon took him to surgery , he found large collection of the blood and fracture ribs .  postoperative he continued to have problems , mot of them relater to his advanced age , his bad lungs and other co morbid conditions. We did take him off the respirator and he did need feeding tube. We  did discharge him to nursing home for the rehab.
    To me this story  elestrate the saying that you can't see (even if it is in front of you) what your mind can not think!!

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