Saturday, March 22, 2014


    I see patients and know that some of them have serious disease and will not make it for long time . Usually when I see patients with wide spread lung cancer , I know that they will not be alive for years . Based on the growth pattern I can see that they may be there for few months or may be couple of years . There are times when with smaller nodules and new Radiation treatment I have even seen cure.But there are surprises . I saw recently saw some incidences , where my judgement was not best .
   I had seen this lady for long time . She was a retired nurse, that I had seen in the hospital as a nurse . She had dry cough and her primary care physician ordered a chest X-ray and it showed abnormality and so she saw me . She had pulmonary fibrosis. I did the breathing test and chest CT scan and confirmed the diagnosis. I was reluctant to start any steroids .So I decided to watch. And many years passed by . She continued to have cough , but did not get worse either with X-ray or the breathing test. I must have followed her for at least 15 years or so . Then she had some colon problem and then was diagnosed to have colon cancer. She was operated and really did well . The only thing that was new was that we did a cardiology work up before the surgery and it showed that she had narrowing of the aortic valve and mild coronary artery problem . Sh was 87years old and we decided to to do no additional procedures. She did very well and was out of the hospital in less than 7 days. I continued to do the follow up.She was getting old and her activity level was down . Her husband who was also our patient, was also having some problems but doing overall OK.
     Then I had a call from the hospital one morning , may be at 11 am . She was admitted with shortness of the breath. It was more than 3 years since her colon surgery. She was 90 years old .She was awake and was short of breath. But still was conscious and oriented. Her oxygen level was low and she was on 100% oxygen. She had loud murmur of the aortic valve narrowing and the crackles , which partly were due to the fibrosis and (as I thought, partly due to water in lungs .) She was not putting out any urine . As I saw her and discussed the care with the family , the kidney specialist saw her . I discussed with him and we decided to start her on diuretics to get more urine out put,so that the water from her lungs would be reduced ..I talked to them and made her DNR . We decided to do only medicines . She agreed and so did the family . She was quite awake and in spite of being short of breath , talked to me .I talked to the nurse and her primary care doctor.
     I was leaving the hospital at 12-30 pm or so and I got a call from the nurse , she had just passed away.I knew that she was not going to survive for long , but I did not expect that she was going to go in less than 2 hours!!!

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