LOYALTY

     Is there a loyalty amongst patients ? This is a question that is often asked today. Now a days patients decide about which doctor to go to, by looking at the list of doctors on the insurance plans and not by talking to other patients /friends etc . But I still do see patients that love me and would not change for anything. They would rather change the insurance plans or even the primary care physician before they wold go to some other physician. Again this does not happen with every patient that I see, but ,it does on many occasion s. This one is a story of one such patient.
     I had seen Dorothy for the 1st time , when she came to me for  shortness of the breath. She was smoker , and had advanced emphysema.I had to admit her to the hospital . It took almost a week to get her better and let her go home . She had to be put on oxygen . We did pulmonary function test and her lung capacity was 30 %. I  continued to see her for next few months and year went by . In next 2 years I admitted her several times and in one of them she had to be put on respirator . I had difficult time to wean her down /off the respirator and we needed to do the tracheostomy . I was however successful in getting her off the vent . then and in next couple of months her trach was removed . This did however  made her think and after great discussion she decided to be DNR--Do Not Resuscitate . Her husband was general contractor and was having hard time . So he had to move about 100 miles from my office .He and Dorothy continued to come to my office and I did admit her couple of times . The routine was he would call me and bring her to my office, and I would assess her and either would adjust medicines or admit her to the hospital. At times it was so late that I would see them in the emergency room or even just do direct admit her without seeing her and see her only when she was in the hospital .
    We had several discussions about her deteriorating health and the risk of not making it . Both of them were very clear , in that she did not want to be put on breathing machine. She was very clear in her mind and thought precess and he was clear about it and was supportive of it.
   On one Sunday, I was making my rounds in the hospital when he called me . It was about 8am and Dorothy was short of breath. She did not have a good night and tried to hold off on calling me , she did not want to be in the hospital again. She was too tired to get in and' fight it '. I told him to bring her to the hospital . He was already in the car and told me that it would make him about 2 hours to get to the hospital .I told him it was fine and called the admitting office and told them to get a bed . They had her information as she was in the hospital several times.
    I continued to see patients. It was 11 am and I had not gotten a call from him . And I got a call . My answering service called me to inform me that a 'state trooper ' wanted to talk to me . I was not too sure as to what was going on . I called him , he asked me if I knew One Mrs. Dorothy . I told him 'yes'. He informed me that she died in the car. He wanted to know if I would sign a death certificate.I told if I would sign it . I talked to the husband . He was driving to our hospital and she continued to feel badly . And then she went to sleep . He thought that she had not slept well during last night, so she was sleeping . In fact she must have gone in co2 narcosis or coma . ( when the blood carbon dioxide goes up , it causes sleepiness and the person goes in to coma). In next 10 or 15 minutes he realised that she was not breathing . He stopped the car and called 911 . That is when the state trooper showed up  , along with paramedics. She was gone and so he called me .
     I told him that this was for the good that she died before getting in the hospital,where she would be struggling for breath and then  after few more hours would have died anyway.