Monday, June 21, 2010


The past few weeks, I've had a difficult patient. His personality isn't difficult; he's a complete sweetheart. His case is difficult. He has lung cancer that is nonoperable. So, he's dying, but not any time soon. About a month ago, he came down with a case of Clostridium difficile diarrhea. It's a terrible infectious diarrhea that is most often caused by giving someone antibiotics.

(Allow me to step on my soapbox...)
Do. Not. Ask. Your. Doctor. For. Antibiotics. Ever. There, I've said it. We can't cure everything that ails you with amoxicillin. Not every sniffle needs Augmentin. Not every time your kid pulls at his ear is it infected. Your body's natural immunity does a darn good job most of the time. If you doctor says it's a virus, go home, drink your 7-Up, take a hot bath, and go to bed. Atibiotics always carry a risk with them, and people forget that. They aren't Tic-Tacs. They are drugs with side effects, some of them dangerous.
(Stepping off my soapbox...)

So, Mr. W got a bad case of C.diff. He got treated for 2-3 weeks, which is standard. His diarrhea slowed down, so they stopped it. However, a week later, the diarrhea returned with a vengeance. We started him on our most potent antibiotic for C.diff. Three days later, no improvement. His tests for the bacteria were negative, but no one believed them. His case was classic for relapsing C.diff.

I doubled his antibiotic dosage. No improvement.

His white blood cell count climbed every day. 16,000. 25,000. 33,000. 45,000. [normal is 6,000-10,000). He was getting weaker and weaker. He lost his appetite. I kept assuring him that it would work. That we would figure it out. That before long he'd be back in the nursing home where he could talk to his friends and watch movies.

The team called me on Saturday morning and said his chest X-ray looked like it had a small pneumonia. I wasn't too impressed by it, and I asked them not to treat it. He had no fever, no respiratory symptoms. More antibiotics would make the C.diff worse. They agreed. Twelve hours later, he had some shortness of breath, so they started some antibiotics. It was a reasonable thing to do.

Sunday, his chest X-ray LLS. That's my shorthand for "looked like sh^t." I think I learned it from my surgical chief resident. More important, Mr. W himself LLS. He was on a face mask delivering high flow oxygen, and he was breathing fast. But, he said he was comfortable. He told me how he was doing. I told him, as I had every day for the past 13 days, "Don't worry, we'll figure this out."

Today, I walked into his room, and he looked like death. He was always cachectic - so skinny you could see his ribs, and his temples were sucken in. But, there's a look that death has. Once you see it, you know it. Mr. W was there.

My eyes welled up. The respiratory therapist (RT) was in the room, giving him a breathing treatment that was clearly futile. I asked how Mr. W was doing, and he told me the obvious. I leaned over Mr. W, and listened to his chest, even though I knew there was nothing I could do. A few tears fell on Mr. W's sheet. The RT said, "Did you know him?" I told him I had taken care of him for the past 2 weeks. He asked me if I was ok. I thanked him for his concern, and I told him I'd be fine.

I just felt like I didn't do a darn thing for Mr. W. I told him it was going to be ok. I told him we'd figure it out. I told him he'd be better soon. None of those things happened. I don't know what killed him. I don't know if he had relapsed C.diff. I don't know why he got septic.

I just know I felt robbed.

I felt like Mr. W was pulled out from under my grasp. I thought I had a hold on him, and I didn't. I thought I could pull him out, but I couldn't. I was robbed. What hurts more is that I feel that Mr. W was robbed, too. Of a few more months. A few more movies. A few more laughs with his old buddies. Yeah. He was robbed.


Ask Angie said...

I am so sorry Erica. I can't imagine the frustration from not being able to figure out what was wrong.

xoMeghan said...

That was just beautiful to read, Erica. Your work and dedication to your patients is such an inspiration. He may have been robbed of a few more minutes, but he knew someone was trying to help him. I have great confidence that you gave him a sense of comfort at the end.