PATCH WORK

    In our general life we are always to to make decisions as to do a 'temporary patch work or do permeant fix'. So the AC is broke and the tech tells you  we can get it working with some  minor or less expensive parts or we can change major things and that will be warrantied . With cheaper work there is no guaranty that things will last but it is less expensive.  The came thing may be for roof repair or car problems. I fell that in medicine  is the same. We see patients in office or in hospitals, that are admitted for some diagnosis and then we fix it but that does not change the underlying problems or treat it . Example will be someone admitted for pneumonia with underlying COPD in smoker . So, we treat pneumonia but the patient continues to smoke  and gets CIOPD worse. We did not address that. This is very clear cut. But I am going to tell you  the story of a patient where this extend to more that such obvious thing. 

  I have know this patient for many years. She had some COPD  and she also had some cardiac issues . She was quite obese and it was to a point that she could not get of her bed  on her own. She was admitted with swelling in her feet and she was short of breath and so she was admitted and we treated her . She had some fluid around her lungs . She was treated and then sent home . She was readmitted and has same thin  and we tried to treat her . In her 5th or 6th hospitalization, she had increased fluid around her lungs , mainly left lung. She was very heavy women. Normally I drain the fluid by inserting a needle. But I was not sure that if my needle was long enough to 'reach' the fluid . So I asked the radiologist to insert a catheter. He agreed , but when he tried to do it he could not get needle long enough and so he was not successful. I had to call chest surgeon. He did put in a catheter under anesthesia. Over period of days one day she got agitated and pulled out catheter. She was treated and discharged . She was back again with shortness of breath and she had low hemoglobin and then she was again sent home and she was  back in hospital and this time her salt in blood was low . 

   During every one of these hospitalization, the problems were same - shortness of breath, swelling of the feet ,fluid around her lungs and low hemoglobin etc. She never was able to get out of her bed , let alone getting to walk Her weight was same and she has nothing else changed . We did 'fix' the problems that we saw , but did we really FIX anything or was that the PATCH WORK - A TEMPERARY BANDAGE ?