|
medpundit |
||
 |
 |
|
Tuesday, June 17, 2003Last week, one of our patients came in. He is a rancher. About six months ago, his kidneys started to fail--we're not quite sure why, perhaps from diabetes. Six months ago we had him seen by a Nephrologist who advised us to arrange a Cardiac evaluation, to see if he was a candidate for transplant, and then send him back. Well, we had his heart checked, and it was fine, but the gentleman didn't follow up. After three months, we traced him down, and got him in. Since my partner was on vacation, I was the one to see him. His Creatinine was 8, and his hemoglobin was 6. His electrolytes were good, and except for problems breathing at night and when he walked out to the pasture, he was fine. It took awhile to convince him he needed to be seen NOW. Can it wait til I get my sick horse checked? NO. You could go six months like this, or drop dead tonite. I want you to get to the hospital now. (I once had to convince a farmer that his appendicitis surgery wouldn't wait til he finished the harvest. We rural doctors are used to this type of discussion). So he went, got a peritoneal dialysis catheter and six pints of blood, and came home. ("I'm too busy to spend three days a week at dialysis).But of course, caring for horses isn't the cleanest job in town, so after a few weeks, the peritoneal catheter got infected. So back to the hospital, some antibiotics and home. Then the abdominal incision dehissed: didn't heal right, and opened up, with blood and dialysis fluid all over. The ambulance crew rushed him down to the hospital, where the wound was closed...and a shoulder catheter placed to temporarily dialyze him... So here's our rancher, in the hospital, with dried blood and fluid down his clothing, scared to death, and ...But there's no beds. Go home. We'll bring you back to arrange a shunt in a few days. Medically this makes sense. The wound is closed. The dialysis will keep him going for a week. The antibiotics aren't going anywhere. His vital signs are stable. No big deal. We'll place the catheter in a day or two when an elective bed opens. So our rancher goes home, very frightened, for two days, comes back for the surgery and dies on the table.Electrolyte imbalance? Too many catecholamines from being frightened causing an arrhythmia? Septic shock from the peritonitis? Or just a very week body that just ran out of strength? I remember a phrase from a historian about people in a famine: There was nothing those in charge could have done, "but if only they had been kind".... How many people are sent home early from surgery for their families to care for them: families who may be non existant, too busy working, or too naive to figtht the medical system? How can we convince people that medicine is simply not about effieciency and science, but comfort and care? I have no answer, but all I know is that a man died in fear and alone in a callous medical system that has forgotten the importance of caring is part of the healing process. posted by Sydney on 6/17/2003 08:38:00 AM 0 comments 0 Comments: |
|
