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.


Facing Death at Forty

She is in her early forties. She is thin and appears fit and healthy. She isn’t. She can’t walk much more than 100 feet before crippling chest pain sets in. She can’t work and she can't exercise. She recently tried to walk to the corner store on her own but passed out on the way. Her cardiologist has told her she is never to walk alone again. It is too dangerous.

She has lived this way for a few years now, cursed with coronary arteries that spasm for no reason, constricting so severely that she has the crushing pain of angina, the sensation that she is having a heart attack. She lives in constant fear that her heart might stop at any time, that one day a heart attack will actually happen.

There are many medications for coronary spasm but she has not been able to tolerate any of them. They all work by dilating blood vessels which means they lower blood pressure. Her blood pressure is low without medications and even the lowest dose of the standard medications results in dangerously low blood pressure. She has seen multiple cardiologists who have discussed her case with multiple other cardiologists but no solution has been found. She continues to suffer. 

I did some online research on coronary spasm and came across an article on the subject written by a cardiologist an hour north of us. I reached out via email and asked the doctor if she would be willing to see my patient in consultation. My patient scheduled a visit as soon as she could. She came to see me a few days before the consult to go over her records. As I reviewed her history I was once again moved by the challenges she faces.

We talked about how hard it was and she shared with me how important her faith is in helping her get through each day, that she reminds herself continually to trust in God. We talked about the reality that God does not heal everyone and that we may not find an answer or a cure. He does not always grant our requests.

With this in mind I reminded her of one of the central truths of our faith- this life is not all there is. Eternity awaits. We tend to focus on our present circumstances but it is our eternal destiny that matters and how our eternity is not dependent on our current condition. We talked about how God’s eternal plan for her has not been altered by any of her current sufferings. His promises are based on His goodness, not our condition. She told me that she clings to this truth everyday.

We closed the visit with a prayer and she went on her way. As she left I reflected on her faith and example. I was reminded of one of the purposes of Christian suffering as described in 1 Peter 1- “These trials will show that your faith is genuine.” Her steadfastness through tough times has shown her faith to be real. I pray that when illness and suffering come to my life I will be equally strong.

- Bart

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