Thursday, February 14, 2013


    When I diagnosed patient with asthma , I am often asked , how did I get it at such an old age or what can I do to 'cure' it , and many a times, what can I do to control it . I often tell patients that there is hardly any disease which is 'cured' . Take for example of high blood pressure, or diabetes .One has to take medicine to control high blood pressure or high blood sugars . He will have to take medicines for entire life . In short neither  high blood pressure nor diabetes are cured . Same is case with asthma , as long as one takes medicines, the asthma is well 'controlled ' , not cured . But there are exceptions to the rules . When asthma is allergic in origin , say allergies to cat ,and one avoids cats he may not get attack of asthma . You may be wondering where I am going with this as far as disappearing patient . Let me tell you a story of this patient .
     I saw this patient with asthma or COPD in one of the hospitals . He was  treated with medicines and seemed to have improved . He was on oral medicines , pills and was OK . I decided to to discharge him . He was given prescriptions and discharged home . I did talk to his primary care physician . That evening I got a call from the physician . The patient had gone home and the was feeling good , but as time went by , he started feeling bad and got short of breath .He called the primary care physician . The office was about to be closed .So he called me . I had no idea as to why he was short of breath ,When I had seen him in the morning , he was OK , his lungs were clear and his oxygen saturation was normal . So I could not add anything to his treatment on telephone . I told him to send him to the hospital , and told him that I will admit him . I called ER and told them to call me when the patient comes to ER . The admissions were done in ER , even though  there may be a 'direct admission ' .I got a call from the ER that he was in ER and the ER physician did not see him as it was direct admit under me , and so they called me  and told me about his arrival and told mre the room number that he will be admitted to . I decided to go the room in next 15 -20 mins .
     I went to the room directly , without going to the ER . He was not there . I asked the nurse , who was suppose to take care of him . She got the report , but the patient did not come to the room .I thought that patient may be still in ER , so I went to ER . He was not there . The patient was not seen by ER physician , so he could not tell me anything about the any medical issues that he may have had . In between I get a call from his son . He had heard that after the morning discharge from the hospital , he got worst and so was being admitted to different hospital , and so he wanted to talk to me about his father and wanted to know as to what was happening . I did not know where the patient was , and certainly had no idea as to his new medical problem . I called nursing super wiser . I also  called security guard . We decided to check all the elevators and even all the bathrooms . I was afraid that he may have passed out and no one knew . It would have been a major issue if he had passed out , even worse had died , and no one knew . He was to be found nowhere . I just thought of something . If his son was calling , then who drove him to the hospital ?I called his son . He told me about patent's sister who had picked him up from the hospital. I got her telephone number .and called her . To my surprised she answered . She was the one who had brought the patient to the hospital .Her  house did not have air conditioning .As the time went by with no AC , in Florida heat and humidity, he felt worse , called the PCP and then started to come to the hospital .The car was air conditioned , he felt better , When he came to ER , which was air conditioned , he felt better . When he was assigned the room , he was feeling so good that he decided to go home , instead of being readmitted . So it was the AC that made the difference . Unfortunately he did not tell anyone , which caused the major problem in the hospital . The end was sweet , but I added one more thing to my list of things that cause worsening of asthma , the air conditioning !!!!

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