Monday,
October 8, 2001.
Inevitability
Index : 45 (+2)
"Groove is in my ass." .... Em
(married for twelve years)
reassured me that married people need different friends too.
SUPERSTAR!
... Dude, Carlos
was in a famous band AND a TV show. He
was also in the chess club, but whatever.
THE SIN GAME
"And all this science I don't understand.
It's just my job five (or six or seven) days a week."We've had a lot of interesting and bizarre new patients admitted this week. Even moreso than usual, which says a lot.
So let's play a game. It's called, "Guess Which One of These People Died This Weekend?" The rules should be self-explanatory.
MR. GLUTTONY
Mr. G was an obese middle aged man with low blood pressure and muscle pains / cramps and no other past medical history. Text book case of low blood calcium ("hypocalcemia") because of a gastric bypass (to lose weight) he got a few years ago. Piece of cake, he got his I.V. Calcium, pain meds, and felt great.
When his Russian girlfriend visited today, she still looked wrecked with worry. When he reassured her in English, his perfect English would shift into English with a slight Russian accent. It was cute.
MR. SLOTH
Mr. S sat on the toilet for 26 hours (and had the muscle enzyme damage to prove it)! He was admitted for disabling back pain and was constipated by all the narcotics he was on. Either that or he must have been reading a really really really good book.
He was supposed to have "cement" injected into his crushed vertebra today (a last resort measure), but he got scared, started hyperventilating in the O.R., and was sent back to the floor.
MRS. VANITY
Mrs. V. was getting a face-lift (her second one) and ended up vomiting with the anesthesia and getting an aspiration pneumonia. She's 59 years old.
I'm tempted to ask her suspiciously,
"How do we know you are the REAL Mrs. V.?"
MS. ENVY
Ms. E. was a young woman with self-diagnosed multiple personality disorder who thought she was having a blood clot or heart attack during a road trip with her friend (who also has self-diagnosed multiple personality disorder) a few days ago.
So she read about it on the internet for a few days and then decided to come into the ER and get checked out.
During the interview part:
"So, you were having chest pains?"
"Yep… yawwwnnn… like right now."
"How bad is it from one to ten, ten being the worst?"
"Ten out of ten right now. I'm really tired, could we finish this later?"
I'm wondering what kind of party that must be like when two people with self-diagnosed multiple personality disorder are in the car for twelve hours. And if they ever get jealous of another personality's shoes.
MR. W R A T H
Then we had Mr. W. This big burly outdoors hunter. Apparently this guy was out hunting … bears … a week ago. He slaughtered himself a big ten foot tall bear, skinned it, and on his way back to the car tripped, fell and cut his leg. Now his leg is infected and he's scared that all the bear blood he "was soaked in" got into his wound, his bloodstream and who knows what else.
He's especially worried about his tongue. "It feels different," he says.
You'd think most big burly hunters who killed a ten foot bear would be proud of that fact and brag and stuff. Not him. He seems strangely reluctant and almost suspicious when we talk to him. He's a little scary in that way.
And I'm wondering what he was doing dancing in bear blood and where his tongue was during all this. (Or if a bear was involved at all. Oh, shit.) He's a really large man.
MR. AVARICE
Mr. A was a heroin fiend. He got admitted because of an infected heart valve. The kind that I.V. drug users are so good at giving themselves via direct inoculation.
He was found in the medical equipment room with his friend by the nurses. Looking for more "equipment," i.e. syringes and/or narcotics.
MR. LUST
Mr. L. was an old man with a desire so deep it would practically scream from his fibrotic marrow. Every two weeks his lungs would heave (short of breath), his heart would ache (angina), and he would become weak again for this insatiable blood lust (anemia). Every two weeks he would need a transfusion.
Lust can be a burden though. The iron from all the transfusions he's gotten has deposited in his heart and other tender organs to the point of dysfunction.
And soon he'll want more again.
WRONG ANSWER
So who do you think died this weekend?
If you guessed Mr. Lust, then you were right.
He didn't die of blood loss / anemia though. He died of overwhelming infection from a rectal abscess. Yeah, I cheated and left that part out. Like you wanted to look at his 80 year old ass anyways.
His exit was no surprise. His son was there. I was there. He was a Do Not Resuscitate.
I watched his breathing slow as I left to answer a page. When I came back, he wasn't breathing anymore. End of his story.
But that's not all. When you deal with the real Mr. Death you learn that he never plays fair either.
The first guy, Mr. Gluttony died as well.
He was relatively young and healthy. Just ten minutes prior, he was feeling fine, laughing, and grumbling about when he'd go home.
Then he suddenly became short of breath, lost consciousness, and CODED.
He got the usual chemicals - Epinephrine and Atropine (a recent article in the New England Journal of Medicine says that the new one "Vasopressin" is no better than plain old Epi) . They did an ultrasound of his heart during the CPR - it was pumping fine but he had no pulse or pressure to speak of. The blood in the syringe looked like faint Kool-Aid though, and his blood count had dropped suddenly.
With each chest compression, his already large abdomen got grotesquely larger and larger according to the resident running the CPR.
And he died, just like that. His Russian wife's worries were not in vain.
You win some, you lose some. That's mortality for you. Most of the time you aren't surprised who dies, just when they die.
This one was different though. I was shocked. My team was shocked. What? How? But not why. There's no point in asking why.
As soon as the resident told me Mr. G died, details started falling into place in my head. Oh my God. He was having an aortic dissection the whole time maybe … the very wall of his aorta had split and eventually ruptured in his abdomen. The "textbook" hypocalcemia threw me off.
Oh my God. I completely missed the diagnosis. And this man I talked to yesterday, who actually thanked us and wanted to go home. This man who told his worried Russian girlfriend everything was going to be alright now ....
I should have known. Textbook cases only happen in textbooks.
And the thing is, I always think of "aortic dissection" in histories like his. This time, I was just fooled. Could have gotten an abdominal CT. Then called surgery. And he'd be all fixed up.
Life saved. That simple. So simple. Next patient.
Not many people can say their own limitations led to someone's death. And fewer doctors would admit it publically ....
It's days like these where I wonder what I'm doing here. I don't want to have this much control over anyone's life … good or bad. This much responsibility. I just want my own life tucked away from everyone else's. I should be in some cave, painting and drawing pretty pictures that have nothing to do with affecting whether someone lives or dies.
Those days I just want a clean life. Unstained. One that doesn't hurt someone or shatter lives by what I do or do not do. One that doesn't tell people they have cancer or their child/sibling/parent just died. One that is unaffected and not affecting of others.
Like whether someone becomes a widow. Or orphan. Or dead.
It's too late to go back to that pure state though. And some stains just don't come out.
[ADDENDUM : These last two entries have been downers, I know, but I wrote this entry before going to his autopsy today. I'm okay now. But I'll talk more about that in the next entry.]
