In the one of the books written by DR Atchut Gavande titled MORTAL, he writes about his grand father who died after age 100 .He was active for long time but when he had problem the 'family' took care of him . This may be due to the fact that there were many members in the family who lived together and they did not have nuclear family with husband - wife and kids. But now a days we are depending upon society - government or insurance etc. rather that family friends etc. This brings me to story for today .
I had known this patient for many years . He had lung disease -COPD , that happens when one is smoker . He had shortness of breath and then we tried various medications and inhalers and he was OK ,but still had shortness of breath. He lived by himself and had not been married. He needed oxygen as his oxygen levels were low . As the disease progressed , he started having retention of carbon dioxide. In COPD - lung disease with smoking -mild disease does not need oxygen . As the disease gets worse, then one needs oxygen and then when the disease progresses lungs cannot wash out CO2 and so then they need more treatment. Now a days we can start them on respirator or ventilator. The machine helps the patient's breath and also 'generates' breath if there is no spontaneous breath by the patient. In past we needed a tube to be inserted in trachea to use ventilator . But now a days we use pressurizes mask system, similar to one that we use with sleep apnea. This is called NIV -Noninvasive Ventilator. So, we started him on that .And he did well . He was stable and awake and could do certain things - physical activity better.
One day he had a fall and broke his left arm and came to ER , they send him to orthopedic doctor to be seen as out patient after having a soft cast. He was home for 7 days and could not use the mask and NIV and came to ER.I saw him and he was stable . We did do some changes in his medicines , but the problem was that with broken arm- and he is left handed , he cannot put the mask on own and so he was not using it when he was at home and so he got worse. All that he needs is to use NIV for 12-16 hrs and he will be fine . But who can put the mask on him and take it off when he has broken arm? He has a friend but she has hip problem and surgery and cannot help him. He has a sibling but they cannot help. So we have to send him to some place . If he has cast the fracture will take long time to heal - may be 2 months and even after that he may not have adequate use of arm. So then he has to be in rehab center and insurance may not pay for that. This is more of a social problem than a medical. But if social problem is not taken care then the medical problem will get worse.
This is the modern day life and it's problems.
