Saturday, January 10, 2009

Surprised by Life!

It's Saturday, and I'm on call. This morning I was making rounds on the wards when I was summoned urgently to the emergency room. There I found Ruth, an adult woman about 30 years old, who appeared to me near death. She had been at another hospital, and her husband said that they weren't doing anything at all for her there. I doubt that this was completely true, as there was some record of treatment in her outpatient record book, and she had an IV in her arm. She'd been ill with cough and fever for several days, getting progressively worse.

As I examined her, Ruth was completely unresponsive, even to deep pain. Her lungs sounded like something in a recording they play to you in your first year of medical school to teach you all the different abnormal long sounds, except that in her all the abnormal sounds were there at the same time. I slipped my little pulse oximeter (thanks Allan!) on her finger, and it read 60%, and that was with high-flow oxygen already being given.

I asked the ER nurse to give her a large dose of a broad-spectrum antibiotic, some inhaled bronchodilators and an industrial-strength dose of IV steroids. (It a long story, but there's an old saying among doctors that no one deserves to die without an industrial-strength dose of steroids.) I ordered some lab tests, had a serious talk with her husband in which I warned him that she was about to die, and returned to ward rounds, expecting to be called back at any moment to pronounce her dead.

It took an hour or a little more to finish ward rounds, and I went back to ER, to see that lady, and to see the long line of other patients that the nurse had lined up for me. I really expected to find either that Ruth had already died, or to be there when she did. Imagine my shock as I walked into the ER and saw this:

That's Rose, sitting cross-legged on the table visiting with her family! Laughing, even.

Her chest x-ray showed severe pneumonia, but pneumonia doesn't respond to antibiotics in an hour's time. Asthma can respond quickly, especially with high doses of steroids, so I'm now thinking that she is a person with bad asthma who got pneumonia. Her CBC was normal, her kidney function is mildly impared. I wrote for further doses of the same medicines that I'd already given her, and sent her to the ward. Hopefully I'll give a happy follow-up in a few days.


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