Sunday, August 30, 2020


   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!!  

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