Sunday, July 13, 2014


      I have been in medical practice for many years. The medical practice has changed in last few years. Many doctors are feeling that patients are more educated and demanding .I feel that educated patient is better than uneducated patient.This does not mean that all the patients are good or bad. I like patients knowing their diagnosis, getting interested in the treatment and know the prognosis. I have had good patients most of the times . I think many or may be most would come to me if given choice . So when someone says 'thank you' ,i like it and it makes my day.I have been given few strawberries, from their backyard to pecans that some one bought for me as they thought that I would love to eat. I have had 84 years old husband of my patient come to my office and show me how to build a stage for a play and offer to do it when I am participating in a play. I have been given books , scripts and many other things as gesture of their good will and expression of their gratitude.I REALLY REALLY DO APPRECIATE ALL THIS AND FEEL PRIVILEGED TO HAVE THESE KIND OF PATIENTS . But the story that I am going to tell is little different.
     I was called to see this patient ,who was admitted to the hospital with respiratory infection.It was 5 pm and I was not very keen on going to the hospital late in the evening. But the patient was one of the doctor's relative . He called me at 5 pm. He had seen her ,the patient 3 days ago for sore throat and given her an antibiotic.She was not feeling any better and so he decided to admit her . So I had no choice but to see her .When I went to see her , I was glad to have gone to see her . She was admitted to regular ward.She was 18 or 19 years old and had no other history. She was not a smoker or alcoholic or drug addict.She had no previous history.She was quite short of breath and her oxygen saturation was low. When I saw her the chest X-ray was done and when I saw it ,I knew as to why she was short of breath.The X-ray showed extensive pneumonia.I called the referring doctor, who was her relative and also put a call to infectious disease doctor. I transferred her ti intensive care unit and after the cultures ,put her on 3 antibiotics.I spoke to the infectious disease MD and he agreed with the antibiotics that I had started . I called the parents and  told them the seriousness of the diseases.I told them that she may get worse and we may have to put her on ventilator.I was however was hopeful that we had started her on treatment soon enough and she being young and with no other previous history, she would improve.I was wrong.She continued to get worse and also had other issues . She was mildly anemic and had developed kidney problem.She ended up on the ventilator and continued to get worse . Her need for the oxygen was getting worse and I had to sedate her . As the need for oxygen and ventilator support got worse that we had to paralyze her.With the need for ventilator getting worse and her lungs becoming stiffer , it blew up and collapsed and we had to put in a chest tube to treat collapsed lung. We had all sorts of consultants on case and we must have put in 4 chest tubes at different times .She needed tracheotomy as we could not wean her down the ventilator for more than 2 weeks. She had several tubes and catheters and lines,that she was on constant sedation drip.All the cultures were negative and the antibiotics were not effective . I had done the bronchoscopy and it did not add any thing to our understanding of her diagnosis. I had started her on steroids and before I  had done some blood tests for a condition called Wagner's disease. This was a long shot and I had thought about it due to the kidney issues and lung infiltrates.Withe cultures being negative I was not sure as to what was happening.
     To my surprise ,the test came back positive . I don't know how many times I must have called the parents and told them that I am not sure if she was going to" make it "We also had to do feeding tube . She was in ICU for may be 6 weeks .I had started her on large dose steroids and she had gotten little better, but not enough. So with the consultation with the kidney specialist, we started her on immunosupresants .There was a risk. Risk of infection ,but also that suppressing ovulation. This was effective and slowly we started seeing an improvement. She did have tracheotomy and was on ventilator and we were able to wean down the support.I was talking to the family on daily basis. This may have been due to the language barrier.The mother did not speak English at all and I did speak her mother tongue fairy well.She was off the respirator and had started feeding on own. Physical therapy was started.She was discharged .and was followed by the kidney doctor. The continued her medication for the Wagner's disease, and steroids were reduced .       She did very well and was off the steroids. She became a nurse and started working in the same ICU where she was admitted for almost 2 months.She got married and moved to PA. I had seen her parents few times , but it was in a social meeting where there were hundreds of people. So the talk was not much. Then I had a call that she was in town and wanted to see me  and if she could come to my house . I said OK and she came to my house . When we opened the door ,I was pleasantly surprised.SHE HAD HER TWINS WITH HER !!. She was off all the medicines and got pregnant and the kids were healthy. She came to my house to personally thank me . This was the biggest reward to me.(from the GOD) 

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