Thursday, August 28, 2014


    In medical practice , we can predict many things and sometimes we are wrong.The possibility that we would be wrong is smaller that we are going to be right. Again if we knew 'everything' , we would be God . But with the modern day medicine, with all the tests that we have , we can predict more accurately than in past. There are many factors that can affect the outcome and can change out chance of being right. But sometimes we are right and it still hurts.I have seen many patients that I thought will not do well, and did not do well. But sometimes the the contact that we have is so short , that I don't think for long time on these cases and don't wright about them . The case that I am going to wright is one where I knew I was facing uphill battle and did not think much till it happened .
     I had seen this 75 years old patient in my office.He was on oxygen when he came to my office.He was seen by another lung specialist.He was diagnosed to have lung issues and was put on oxygen and some other medicines.He had brought with me old X-ray from 4 or 5 years ago. I reviewed the CT scan done by the hospital and when other MD was seeing him . He was told to have COPD in the beginning and was treated with medicines . Then he was found to have elevated pressure in the lungs and was put on Viagra.I was not sure if they had told him that his major problem was not COPD though he had smoked ,but it was scar tissues in the lungs. I could see that even 4 or 5 years ago he had some scars.I ordered new CT scan and a walk test to see how much oxygen he would actually need . He walked may be 30 feet and oxygen dropped . We continued to increase the oxygen and by may be 4 minutes , we needed 8 to 10 L and he was still not greater than 90%.(which is considered low.)I told him not to walk more than 30 feet.I told him about the diagnosis and told him that not much could be done .I could try some new medicines, but they would not be successful. But he was reluctant for additional medicines.
      He was admitted to hospital in next 10 days. He was short of breath, but main problem was his blood pressure was low and he had low sodium. He was given water pills and they had caused him to be dehydrated and so the blood pressure was low and sodium was also low.I had to give him lot of fluids and steroids and very high oxygen flow . He was put on 100%oxygen with 60L flow (compared to 10 L at home ) The blood pressure was an issue for 2-3 days . But then the oxygen continued to be problem. I could not wean him down . I talked to him several times . We talked about going to special place called SELECT or go to Hospice . He told me that he had no relatives . He was writing a book on Bible,and wanted to complete it.He did accept the fact that he was 'bad' and may not make it for long time.He finally agreed to be DNR. It came as a surprise to me that after struggling for more than 2 weeks , we could reduce his oxygen. I had given /tried several medicines in desperation. Either they were working or it was just a 'chance'.He agreed to go home with Hospice .
     He was on 8 L and I had told them to have as high as 12 L oxygen.And 4 days down the road , I got the call from Hospice , that he passed away.I knew that this was going to happen , and I knew that it would not be that long . But 3 days ? It hurts.


  1. It hurts because you're human and that's what makes you an excellent doctor.