TALE OF TWO PATIENTS

 
     I have written about the old patients  add the 'Age Old Problem'. But we can not avoid this problem and each one needs different approach . My problem is that in modern day medicine , the hospital doctors  and even many primary care physicians do not have the time .So it it ends up to some of the consultants who tend to spend more time to do things that is sometimes their specialty. I have seen this time  and again and the problems are not same though similar.
    I recently saw 2 different patients Both have passed their 90th birthday . Both had some dementia  and limited mobility and one of them had not gone out of the house for 2 years or so. one of then had some cardiac issues  and also had cardiac issues. He had some lung issues  and had seen lung specialist  and then no new tests were planned . He had heart rate problem and so the cardiologist decided that he needed a pacemaker . So he had a pacemaker inserted  and things went well  But then he had problems with breathing . His oxygen dropped  and he had to be started on oxygen and then he continued to have more and more need for oxygen . So I was called in . Withing a very short time after they called me for consult, lot of things happen . The patient was DNR,not to be put on respirator or had CPR done. But then the family decided to change their mind  and so they put him on  a machine that delivers oxygen with pressure  and he had new chest X- ray and also was given some medications. I had not seen patient and I was called again in less than 15 minutes that the patient did not want the pressurized mask  and the family decided that he will be again DNR  and no machines . But now the problem was that once you resend the DNR  and start the 'life prolonging machine', we can not just stop it. We need to do what is called 'withdrawal of life support.'So we need family / patient to agree  and sign forms  and we need 2 physicians to sign the forms . I came in and saw the patients  and discussed the case with nurse  and cardiologist and also to several family members  and also to patine. They all agreed  and I signed the forms  and changed him to a special oxygen delivery systems.
      So we went back and forth and he was DNR, and then i started him on some medicines . I thought that he had some chronic lung problems  and he may have aspirated - fluid or food going wrong way in to lungs - and we do see that in elderly patients not uncommonly,  and so we started treatments. To make the long story short he continued to do better  and he did recover to his base line level.
     I will talk about the other patient in my next blog.