Saturday, May 11, 2013


    We all know or talk about somebody dying suddenly . Someone that was OK at one minute and is gone the next . This is commonly said to be the sudden death . In medicine we talk about sudden death, in which case person gets fatal arrhythmia , fatal , if untreated . That is the reason why we now a days see defibrillators in all the public places and even in police cars . But I am not talking about these cases . The are part of our life , especially medical . I am talking about different type of patients .These patients leave me speechless or may be the other way , that I tend to talk about them to anyone and everyone that is willing to listen to me .
     I knew this 62 years old lady , who had advanced  COPD , the one that you get when the lungs are destroyed by smoking. She was oxygen dependent and could walk may be 200 feet without getting short of breath. I had talked to her on many occasions about quitting smoking and she knew that she needs to , but had not been successful . She was on all the medicines that I could think , even the steroids .It was Sunday evening , I was to attend a graduation party  at 6 pm or so . I was thinking of going to Gym and then come home and go to the party , I got a call from the ER , My patient , let us call her Mary was in ER with pneumonia . She was short of breath and the doctor in ER had treated her with the oxygen , antibiotics , steroids and the other medicines . She was 'much improved ' but she needed to be admitted to the hospital. I had no choice but to go to the ER as I knew this patient quite well . In past she needed to be in ICU and needed a machine to breath . I went to the ER  .
     I saw her in ER . She was sitting at the edge of the bed . looked quite comfortable . , was on some oxygen and oxygen saturation was good . Her heart rate was normal , but her blood pressure was little low . Her X-ray showed pneumonia and her white cell count was elevated .Her mother was with her . I looked at the other data . spoke to both of them and spoke to the hospital doctor , who was going to admit her . I told him that she looked OK , but with her low blood pressure , not that bad (95/60 ), and her previous history , I would out her in ICU . I did my paper work , dictated my note and saw her again in ICU . She was OK , but I did mention to her and her mother that if she does not improve , or gets worse we may have to put her on respirator , to help her breath . She told me that she would agree for noninvasive way of treating , and did not want to go on any 'machine '. I was OK with that , as I was not expecting any major problem .I left the hospital .
    I was leaving for the party , when I got a call from ICU . She was not doing well and her blood pressure had dropped and her breathing was labored . I told them to start some other medicines and told them to put her on BIPAP , a noninvasive way ventilation . I spoke to the mother and the nurse , they did not want any machine , but agreed for the BIPAP. Over period of next 12 hours I continued to get several calls . Her blood pressure continued to be  a problem . In spite of different medicines that I tried it was barely 100. .She was not breathing well and had issues with carbon dioxide retention. She also had no urine out put .
   I saw her in ICU next morning . She looked horrible . She had no urine , was maxed out on medicines to improve her blood pressure , looked swollen , with all the fluid that we had given and none had gotten out as she had no urine .Her breathing was almost terminal .I spoke to her mother and her brother . I had no hope . I told them that even if I would do 'everything ' that I could do , including all machines , she was not going to survive . They agreed for the" comfort treatment only ".
   She died in next couple of hours . It was little over 16 or 18 hours ,that I was talking to her . She was sitting at the edge of the bed talking to me as she used to do in my office . I never thought or predicted that she would be gone in next few hours, and if some one would have told me that she was going to die , I would have told him or her  that they don't know what they are talking about .This I call SUDDEN DEATH . I don't think I am writing this as I DID NOT PREDICT THE OUTCOME , but I know we can never predict the BIRTH or the DEATH in any case .    

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