Saturday, June 17, 2017


      I was reading an old book by one of the Indian authors. There was a story in which there was  a subplot . They had mentioned a story from a book of stories called 'ISAP NITI'. Isap is a slave and he had ability to understand the languages of the animals. So he had these narrative stories , in which the birds and the farm animals and the jungle  animals talk .Each story was telling some moral. So the story which was mentioned in this book was as follows . There was a bird's nest in a tree and the the the new ones had hatched. So one day the farmer comes in and looks at the trees and tells the servants that  the trees need to be trimmed. After listening to the talk that the tree will be cut , the little ones in the nest got scared and so when the mother came home, they told her the story and told her that they have to move , The female asked them as to who was going to do the job . So the birds say that the servants of the farmer. She tells them to relax. This is repeated and each time the servants are ti=old to cut the branches the mother tells the little ones to relax . One day the kids tell mom that the farmer had come again and this time he said that 'I am going to cut the tree tomorrow!" The mother tells the little ones that they have to move right away ! .The moral of the story is that if you want something done , you have to do it yourself if you want to be sure that it gets done . This brings me to my patient story.

       I was called to see 35 years old male , who had chest pain and so he came to ER. He had chest x-ray done  and it showed collapse rule out heat attack. He had a chest catheter inserted and then he had a CT scan  of the chest . The CT scan showed that his lung had partially expanded and there was still significant air out side the lung . He was doing better and was not short of breath and was not needing the oxygen.
      So I saw him and saw the CT scan too . He was more than a pack a day smoker and the CT scan showed  that there were several blebs or blisters on his lung . My feeling was that one of these blisters or bleb ,ruptured and so then the air leaked and the so the lung collapsed. With all these blisters on the lung I was concerned that this can recur and since his lung has not expanded completely , he may need additional chest tube or even surgery. I was worried that trying to insert new chest tube with all the blisters could ,one of them could rupture and then there would be major air leak.

      So i told him that he should be seen by chest surgeon and may be he can do new chest tube or just take him to surgery and clip the blisters and put in some talcum powder .To do this he needed to be transferred to the other hospital. So I called the hospital doctor. and also called a lung specialist in the other hospital and also called the chest surgeon . the surgeon felt the same thing and was willing to accept the patient .
    In doing all this 18 hours passed by and then 24 hrs , since I mentioned to him about the transfer . The next thing I knew was that the hospital doctor calling me telling me that the patient left the hospital with the chest catheter without telling any one . I did not know what to do . He had threatened the same before when different lung specialist had seen him and they did not get along and that is how I needed up talking over. But I had talked to him and the family extensively and printed pictures and told him that he will not do well without medical help. So my hunch was that he will show up and show up at the other hospital .

       I got a call from the other hospital that  he was in the ER !!!!

(In this story the patient decided to do the transfer on his own  rather than waiting for others to do it . I am happy that nothing went wrong , but this was not right thing )

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