In medicine we have seen many a times the sorrow and the grief and sometimes some or all doctors feel that they help patients to relieve them in their miseries. I also feel that we do certain things to help alleviate the pain and suffering. But sometimes the problems are profound and sometimes simple . Someone with stage 4 cancer wants to beat it and we know in our heart that that is not likely to happen, but we understand the request and know that this is VERY difficult to fulfill .But sometimes we have very simple request and we still find it difficult to fulfill it. This brings me to the today's story.
I saw this patient who was a 78 years old female. She was diagnosed to have pneumonia and so I was consulted . When I went to see her ,she was somewhat cachectic patient who was in bed. her caregiver was with her . She was looking good and not sick and she also had her facial make up well done even though she was in hospital. I asked her some questions and then the care giver told me that she can not talk and she can understand and she will answer the questions with her PHONE. She could not write on paper . She was not a smoker and she had not had any history of excessive alcohol intake. She was diagnosed to have ALS - also known as LOU GEHRIG'S disease.This is neurological disease and there is slow or sometimes rapid progression of muscle weakness and it disables the person. She had that and she was unable to do much and she had electric scooter and also a wheel chair and has kept up some motility . But the disease affected her jaw muscles and she could not talk and also could not swallow. So she had feeding tube inserted directly in stomach called PEG.She had taken water and then she started with cough and so she had aspirated . So she had shortness of breath and she came to ER and then chest X- ray wa done and that showed that she had pneumonia.
She was comfortable and did not need oxygen supplementation and she had no shortness of breath and no fever.I had seen the chest X- ray and other tests and she seems to be stable. She answered my questions on phone texting - writing and the care giver was also giving me most of the answers. I examined her and told them the aspiration and also the precautions and she also had hiatal hernia and so I told them all the precautions that she needs to follow . Certainly she can not have any thing to eat . As usual I asked them if they had any questions . The care giver and the lady communicated with her very well even though she could not talk and so she told me that patient had a question. The patient could not talk and so she had to write on her phone and it took some time . She showed me the phone -she had written 'CAN I HAVE A SIP OF WATER ?'
A simple request and I was not sure if I could grant it . I had big explanation and told her that she could take a 'chance' by doing it and she may have aspiration and pneumonia . But I did compromise .I told her that she can have a small ice cube on and off . My thought being that the ice will dissolve slowly and the amount of water that is in her mouth would be so small that it will not cause problem..
Such a simple request and such a complicated answer!!