Saturday, December 12, 2020


       I have tried to avoid talking about the pandemic with COVID as there are so many who have written and talked about it that my blog would be nothing new . But what I have realized in this pandemic is that the disease is not as simple as other diseases that we have encounter in out routine medical practice. It has many faces  and it is possible that we may be having "training on job "type of situation. I had state it in past either on my YOUTUBE CHANNELL or in one of the blogs or may be in some group discussions that out  mortality was high in the beginning as we did not try simpler way of providing oxygen  and respiratory support. Now we are not doing that and the mortality is reduced. So i have stated many times that this reminds me of old Indian Story of 7 blind men and Elephant. There were 7 blind men and they had not seen an Elephant . So they asked their teacher to describe the elephant . So the teacher took them to a place where they could touch the elephant  and 'know' for themselves how the elephant may look like. So one blind man who was touching the back of the elephant said that the elephant is like a wall , The other one who was holding the tail stated that No it is like a rope and thisrt one who was touching the legs stated that no ,no it is like a pillar  and so on. So each one was touching some part of the elephant and felt that he 'knew' how the elephant looks like. That brings me to today's story.

   I have known this patient 74 years old for last several years . When I saw her for the first time she had what looked like a pneumonia  and so she was admitted  and I saw her . She had pneumonia, but it was due to obstruction of a bronchus with a cancer  and she also had COPD -lung disease due to smoking . So I treated her and had her see a chest surgeon and he operated her and the cancer was resected  and she did well and did not need any further treatment in form of chemotherapy or radiation. She was followed and she had no problem . Then early part of last year she was admitted  and she had pneumonia  and I was called again and i saw her . We treated her with antibiotics and she had CT scan  and then I did Bronchoscopy to make sure that she did not have cancer and she did not . We did do follow up CT scan in 3 months  and she had complete resolution of the pneumonia  and CT scan was clear. Last month her husband got sick day before the Thanks Giving  and went to walk in clinic  and was diagnosed with COVID . He did not want to go to hospital and decided to get treatment as out patient and watch . She was OK  and then on Friday after Thanks Giving ,she got sick and she went to ER and was admitted to hospital. I saw her and she needs minimal oxygen and she had no fever and she was not short of breath . The chest X- ray did show that she had pneumonia  and her COVID test was positive. But she also had diarrhea  and so she was dehydrated  and her kidneys were not functioning normally. So we started her on treatment for regular pneumonia a nd also for COVID . The infectious disease specialist also saw her  and she was on steroids , oxygen and Remdesvir. I watched her every day and she was stable for 4 days  and was to complete the treatment t in one more day. And her condition got worse  and she needed more oxygen , So now she was on 12 L oxygen and then next day the chest X- ray got worse and oxygen dropped  and so we transferred her to ICU  and she needed to be on PAP - machine that generated pressure to deliver oxygen -- which we were not using due to fear of spreading COVID only 3 months ago. She continued to need it for 4 days. Shas done better but still not completely out of wood. So she did all the right things . She went to ER when she had problem , got hospitalized and was seen by specialist and was started on treatment with current medications and seemed to improve -only to crash after the treatment was completed I am not sure how to explain this . 

    Her husband decided to stay home for 1 week and then when he got worse , he came to ER  and had to be put on ventilator and continue to need ventilator for long time  and is sick  and has improved minimally.So he did not do what he should have done  and paid price for it .So I am not sure in this family matters who is right and who is wrong !! ,  

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