Archive for the ‘Patient stories’ Category

Joe the Diabetic man is waiting for his cure

October 7, 2009

I am on the plane to Houston to present today and a friendly cheerful man looks suddenly bruised when the flight attendent spills water on his laptop. “You know, if I did not have diabetes, I could make FIFTY times more than I am making. I normally eat VERY healthy ” he says as the last of the coke and pringles pas his lips. “But my sugar was low when I got on the plane’. He is taking state of the art therapy with Glargine Insulin and an ultra short acting insulin.

“Have you thought of having an insulin pump placed” I ask. In  “Routine Miracles’ the unparralelled triumph from the point of view of the patient is the insulin pump.  No more running into bathrooms to check a finger stick and inject insulin. Freedom, and the feeling of being ‘normal’ are the benefit.

“I am scared of breaking it” he says. “In my work and in my social life, people are always touching me and hugging me, I am scared it will break”

“You can always remove it” I say.

“I have the best eye doctor in the world. Besides laser treatment, I get avastin (Bevacizumab) injections once a month and it has kept me from going blind”

I pause a moment to absorb the grandeur of this advance. How exalted and wonderful to live in an era in which type I diabetes still can be managed to allow the ebulient Joe to travel to see a U2 concert in Atlanta.

 Vascular Endothelial Growth Factor (VEGF) inhibitors are used, off label, to stop the progression of Diabetic retinopathy. Joe lives with Type I diabetes and we have a hard time absorbing or remembering that it is only in the last few decades that type I diabetes was not a death sentence.

The previous generation of physicians did not cure diabetes. Let us take a moment to absorb all the Hope and Goodness of a man who is alive, vibrant and  hopping a fast plane to Atlanta to see Bono.

Joe is waiting however. He is waiting for one of use to cure his diabetes. Help me spread the news.

Taking Care of a prisoner in the Emergency Department today

September 12, 2009

He is lying in a bed in the emergency department with his hands cuffed behind his back. He has a bandage on his head. Two men with nine millimeter guns at his side read the paper and wait. “Tell me what happened?”  “The cops beat me up!” says the man.

I do not want to get involved in that squabble. I do not want to enter into a litigious battle. There is an injured human being in front of me. The cause, who is right and who is wrong are not the point.

He is safe? Is he in pain? How can I help? Does he need surgery? Sutures? Drainage of a hematoma? That is my concern.

The cops, calmly, without defensiveness tell me “He fought several officers and made a grab for a gun. He could have killed someone”

I don’t want to hear this either.

What are the facts? Is he in need of help? I do the exam, I order the CT of the Maxilla.

Would the world be better if I had treated him as right or wrong in the cause? Is the civilization better if I treat a prisoner toughly? or villify the cops?

A human is injured. He needs help. That is all of my concern.

Chest tube placed: Entering Sacred space

August 25, 2009

The man relaxes after a few more milligrams of Dilaudid on top of the Versed. His muscles and face  visibly unclench. Two pairs of hands are dissecting through the soft tissue and muscle that hold his ribs together  and forceps are a finger’s depth into the man’s chest.

It seems savage and caring at the same time, placing a chest tube. Empathy has to be selective in the Deli sandwich of sensitivity and disregard that comes with needing to burrow a hole in a man’s armpit betweet the 4th and 5th rib.

This is my first day in the emergency department in 17 years. All the pain and smell of the world’s suffering and compassion tweet into my presence in a dense emergency department that thankfully will be demolished and rebuilt over the next few months.

I find the man I am trailing today, Faiz Khan, to be “Routinely Heroic”. The kind of ‘day to day’ in some people that does the right thing, and compulsively is thorough.  Divine presence influencing the world of ordinary events.

The patient wants to know why he has a spontaneous pneumothorax. “It can happen from any type of lung disease, or from trauma, none of which you have.  We don’t know, that’s why we call it ‘spontaneous’.”

It’s VERY important to tell the patient ‘we Don’t know’ when we don’t. Otherwise his mind will ascribe blame to something he did wrong, or bad luck, or being cursed. 

Sometimes, we just don’t know.

A man with a spontaneous pneumothorax is rescued from his breathless existence. The chest tube is in and his pain is relieved.

Two doctors, an attending and a trainee have to switch off enough sensitivity to dig into the sacred space of the man’s chest cavity. “Slice, not stab” is the instruction. He is right

Just enough sensitivity to relief pain.

Our unique heart. Receptive and immune.