Monday, June 16, 2014


     Many a times I am asked if patients care to know if patients care as to which physician they see. Now a days we have many HMO and patients enroll in to them based on the 'benefits',rather than which doctors participate in to it or if they can go to their previous doctors. I can not not say that every patient that I see or for that matter any other doctor sees , does care for their own doctors , but I can certainly state that majority of my patients would like to come to me rather than going to someone else , simply because of the new insurance plan .I think I am lucky to have these patients ,that care for me as much as I care for them . The story that I am going to tell is one such story , that touched my heart. Unfortunately the end was not sweet.
     I was seeing this 63 years old female who had smoked for many years . She had developed very advanced COPD and within short time after I started seeing her ,she was put on oxygen.She was short of breath walking 50 feet . She had significant cough and got recurrent respiratory infection . She also needed to be put on steroids on and off.I

    I continued to do the follow up and in next 2 years she was in the hospital few times . She continued to get worse , but had strong will power and did walk at times , but then ended up in a wheel chair. She knew that her disease was bad.She was on respirator twice and each time it was difficult to wean her off respirator. The second time she was on the respirator for 14 days and came very close to having tracheostomy. After that incidence , when she was about to be discharged , we talked about the DNR .She told me and the husband that she did not want to be ever put on respirator again. She would rather die , than go on respirator for test of her life --and I did feel that it was possible that next time she may not be in position to be weaned off.So we agreed that we would do everything medically possible but no artificial means .
     She was admitted to hospital once and did OK . The husband was a builder and the economy was not doing well , and the construction was down . So he could not survive , so he sold his house and moved to a place 80 to 90 miles from my office . It was much smaller place and he had gotten a job near by . He still continued to come to me and I continued to follow her.
    I had admitted her in our hospital , when the husband would call me, telling me that she was bad .It was one Saturday morning.I got a call from the husband that she was not doing well and needed to be admitted . I told him to take extra dose of steroid and get her to local hospital , if she was bad . She did not want to go to local hospital.She lived 80 to 90 miles from our hospital . So I expected her to take at lest 2 hrs. So I told the husband that I will make arrangement  for her to be admitted and I will see her when she is admitted . It was about 10 am . So I thought that by the time I am ready to leave the hospital , she should be arriving. I called the admitting office . As she was admitted to the hospital before , they had all the information about her . I also left the preliminary orders like blood count x-ray , steroids, and other orders , in case I had left the hospital before she came in.
        She was not in the hospital by 12-30 pm , I was going to wait for short time and call the husband on his cell phone and ask him on their where about.Then I got a call from some unknown telephone number. I called the number and it was sheriff, highway patrol.He asked me if I knew the patient . I said yes . He told me that while the husband was bringing her to our hospital , she died on her way to the hospital . He wanted to know if I would be willing to sign the death certificate.I said off course. I spoke to the husband , there was not much to add . He had asked her if she wanted to go to other emergency room or hospital , and she had told him 'no '. She did not want to be treated by anybody other than me.

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