Thursday, November 22, 2018


     In medicine I see all sorts of things , some routine and some not so routine . Being a firm believer in reincarnation , I try in my own mind wonder as to the cause of the miseries and also how people behave..I am not enlightened enough or may be enlightened at all , that I can explain everything and my hope is that one day I will meet someone who is enlightened  and guide me to be enlightened . Until then I use common sense and power of deduction .Many years ago I had asked some one that I thought was better than me about this question . In criminal code , the judges were given guideline as to what punishment would be appropriate for particular crime. So is there a Sacred Book that will tell us to the punishment that one could expect if he deviates from the RIGHT thing . So if I take a pen from the hospital or a towel from hotel etc what are the consequences of my action ? So if I am aware of the reaction to my action , I can better decide as to do it or not. But there is none . I have heard that the SUICIDE is one action that has very strong or bad reaction . I do not know why .But this brings me to the story of a patient today .

       I saw this patient , may be 71 years ole for chest congestion . He has been smoker in past and he had mild high blood pressure that was well controlled with medicines . He had cancer of the throat - larynx , and so he had surgery and he had to use a hand held machine for speech . He was doing well . But had noticed some chest congestion and he had cough and then he would get short of breath . When I saw him in office , he came with his wife . His lungs sounded clear and he had good oxygen saturation and e was quite comfortable . His PCP had done chest X- ray and that was fine . He had the laryngectomy stoma -when the larynx is removed there is a hole in the front of the neck and one breathes through it rather than nose or mouth .The purpose of the nose and the hair in the nose and the mucous membranes in nose and the throat is to 'filter' the air and make it warm .So the dust and the cold air does not go to the lungs . When you bypass the nose and the throat , this advantage is lost . So the bronchial tubes get dried out and the mucous becomes thick and dried. This will cause problem as one can not cough up thick mucous easily . So I told him to use humidifier as much as possible for the laryngeal stoma and also put him on nebuliser treatments with medicines that could open the bronchi and help the secretions. He did very well . I continued to do follow up and he was stable patient for more than a year .

    One day he called me and asked me for an antibiotic. He was congested . So I did call in antibiotics , but I also told him to do more nebuliser treatments  and also started him on steroids. He got better but he again called me in 2 weeks and wanted to have more steroids and antibiotic . He had similar problem again . So I  saw him and he was OK and I did again the same thing . He got better .
3 weeks passed by and he called me again . He has am problem . This time I told him to come to ER as I was not sure why he was having same problem all the time . So he came to ER . I saw him in ER .He looked about the same . The lungs were clear and he had good oxygen saturation . The blood pressure was OK and even the chest X- ray was OK . There was no pneumonia or any other abnormality . He had no fever and he was comfortable. I decided to admit him and treat him for respiratory infection..We could also watch him , give nebuliser treatments round the clock and steroids and the antibiotics  too. We can also suction the airways if needed . He was not very happy . He was feeling fine and all that he wanted was antibiotics and some steroids.

       I saw him at 6 pm and that was the last time I saw him . At 1 am he had cardiac arrest and he had CPR  and he died .I was shocked and so was the wife . I called her at 1 am and told her to come to the hospital ASAP . She did but it was too late . I spoke to wife again next morning and then she came to my office to thank me when I had not done anything . ( I think in her mind I ADMITTED him  and so she did not have the burden of guilt if he had gone home .)
       I also saw her in hospital one time and she hugged me and again thanked me . She looked OK She was still mourning but who would not after loosing a spouse of 40 years plus . Then one day a nurse told me . She reminded me of this patient and asked me if I remembered the patient. HOW could I forget /

   She told me that his wife committed  suicide  and shot herself ! 

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