5 Lives Saved in 5 Days.

It was a scary week. It began with a call from the lab about a patient’s lab results. They were so abnormal that I was surprised the patient was alive, much less able to function. I sent him to the ER immediately. It took a week for the labs to approach a normal level. He was deathly ill. What was frightening was that the tests were ordered as an afterthought during a visit for a mild complaint. Just before I walked out of the exam room I remembered that the patient had a history of abnormal labs years earlier. Although this was not why the patient came in I decided to order the blood work, just to be thorough. If hadn’t the patient could have died. 

The next day a patient came in for a routine follow up visit. During the visit he thanked me for harassing him into getting a colonoscopy the previous year. He didn’t want to get it done but I argued that it could save his life. It did. He had a large precancerous polyps removed. If he had waited a few more years it might have been life-threatening.

Thursday morning my PA (Physicians Assistant) asked me to take a look at a patient she was seeing. The young man had been sick for a few days and had just started having shaking chills with a temperature over 104. I walked in, took one look at the man in his 30’s and said, “You need to be in the hospital.” He asked if he could treated in the office and I told him the only debate in my mind was whether to call 911 or let someone drive him. He was septic. Gram negative bacteria were found in his blood stream. When he walked into my office he was hours from death.

Friday morning saw a man come in for a refill on his blood pressure medications. The PA thought he didn't look right and asked me to take a look. I had known the man for years and the change in appearance since his previous visit was striking. He was severely jaundiced. He was admitted to the hospital with liver disease and a potassium that was dangerously low, low enough to trigger an irregular heart beat.

An hour later the PA grabbed me again as I came out of a room. There was another patient she was worried about. The man in his 60’s had mild chest pressure but an elevated heart rate in the 160’s. Although his blood pressure was normal and he did not feel that bad I had the staff call 911. The paramedics were there within a few minutes. They bundled him up and put him in the ambulance. Shortly after pulling away from the curb, his heart rhythm changed to ventricular tachycardia, a life threatening rhythm that can lead to sudden death. He needed to be shocked back into a normal rhythm. 

When I went home Friday afternoon I was emotionally drained. I do not typically have so many near misses in such a short period. I found myself thinking about how easy it would have been to miss these diagnoses. If we had waited to order lab tests, not pushed for the colonoscopy, given the septic patient oral medications instead of sending him to the hospital, refilled the BP meds and scheduled a follow up or not called paramedics, patients could have died. I was grateful that I have a PA who is diligent and excellent and that together we had come through for our patients.

Each case reminded me of the importance of relationship in medicine. The young man with abnormal labs is alive because I knew him and remembered his lab work from three years earlier. The man with the colon polyp trusted me as his primary care physician and as a result followed my advice. I had seen the septic patient before, and as a result I could tell in seconds that he was not himself, as I could with the man with the liver disease and jaundice. While relationship did not aid me in the diagnosis of the heart rhythm, it was the reason he was seen immediately when he called the office. 

Relationship is being devalued in health care as patients change insurance every few years and are forced to seek new doctors and hospitals. This week reminded me that relationship matters.


It's a Zit Emergency!

“My son needs see the doctor about his acne, TOMORROW!” The receptionist was caught off guard and unsure how to respond. While it is our policy to always see patients who have an urgent she was pretty sure that there was no such thing as a zit emergency. The call came on a Thursday afternoon and we were booked solid on Friday so she decided not to work the patient in. She took a message and told him we would call him back later.

At the end of the day they brought the message to my attention. It seemed a little absurd and unreasonable to the staff that someone could expect to be seen last minute for pimples. I almost never turn a patient away but they let me know this was not a time to go soft.  They told me that I spoil my patients and do not say “No” enough and they made it clear that this was a time when I should put my foot down.

“This is ridiculous!” they said, “they should have planned ahead of time. It is not your responsibility to bail them out because they forgot!” The rant lasted a few minutes/

They were right on every count. It was absurd and unreasonable. No doctor could reasonably be expected to squeeze in a last minute pimple appointment. (Pun intended!) They should have planned in advance and it was not my responsibility that they hadn't. I had every right to deny the request and no one could tell me I was wrong if I did.

But the thought came to me, “Is it only about being in the right?”

I thought about my Christian faith, which teaches that all people have gone astray and turned against God’s plan, and that we are all deserving of punishment. I thought that God could have looked at me and said, “You are going to hell!” and He would have been RIGHT. But God didn’t do that. He looked at me in my ridiculous stupidity and wrongness and decided that instead of punishing me, He would send His Son instead. He overlooked my wrongness and went above and beyond to help me.

With that in mind I told my staff that while we could turn the patient away and be “right”, overlooking their wrongness would only add 15 minutes to my workday. So together we all agreed that we were right and the patient was wrong, but that we would see the patient anyway, because that is how we would want to be treated.

We saw the patient the next day and I refilled the acne medication. I do not think that he appreciated or understood that he was being done a favor or that a special allowance had been made. That was okay. For me, the reminder that it is not always about being right was its own reward.

-          Bart

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