THE GREEN PATIENT

I was called in to see a patient. This one was unusual. I had seen him past . He was 78 years old white patient , that I had seen him in past . He was getting weaker and had pneumonia and was admitted to the hospital . I did the work up and while doing this he continued to get worse and I had to put him on respirator. Before that we had done the swallow study to see if he was aspirating, food and liquid going wrong way . So instead of going in the stomach , it would go in the lungs. Here it would cause inflammation and pneumonia. So we had to do feeding tube . His son was not very happy , but did accept it . When I did further work up , we found put that he had a myopathy. i.e. gradually weakening and wasting muscles , that added to the problem . I did not think he had a great prognosis and I tried to to talk to the son and make him DNR--he was all ready on the respirator , but not to do CPR or 'shock ' him , if the heart would stop. The son was not agreeable. So he was transferred to the nursing home . As expected he was re admitted with pneumonia. ,and I was consulted .
      I saw him in ICU There was not much to see or do . He was supported on the respirator , the blood pressure was OK , mildly elevated temperature. The x-ray showed the pneumonia. The only unusual thing was that he looked 'GREEN'. When I talked to the nurse, she agreed with my observation . On f further examination , we noticed that his secretions suctioned from the trach. were also green , even the tears were green . We have seen jaundiced patients when every thing is yellow, but never saw GREEN patient and green secretions.
    We had done cultures of the sputum and it had grown a bacteria called pseudomonas aerogenosa. ( I am not sure why the names of these bacteria are so difficult ).I called CDC to see if the infection with this bacteria caused this green colour . In between the news that we have green patient spread . No one had seen green patient . and so everyone came to see him . As  a record we did take the picture too . The son was extremely upset . I was not sure as to the cause of  green patient . The son was convinced that it was due to the infection that the nursing home had 'missed '. After talking to several people I found out the cause of his green secretions . He was getting tube feedings. The tube feeding nutrition liquid can be go wrong way and to detect it they added green color to it . This got absorbed and caused the green color to the patient and even the secretions . Now a days no one adds any color to the tube feedings . The mystery was solved .
      The only good thing that came out of this hospitalisation was that after extensive discussion with the son I made him DNR  and once the pneumonia was better we transferred him to the nursing home .