Life on Medicine can be really sad sometimes. Today's patients were especially sad.
My first patient was a 32 year old man. He was having trouble breathing so he went to the ER. He weighs well over 400 pounds. That in and of itself is what makes me sad - that this man has just begun his life and is so limited in what he can and cannot do. He did have a really interesting case, though. He has low O2 sats naturally ("natually" due to his morbid obesity) and has sleep apnea and his O2 goes far down while he's asleep. So the ER people put him on an oxygen mask with bipap to help with his O2. Unfortuntely, he is a chronic CO2 retainer (we think) and the extra oxygen told his brain he didn't need to breathe so he didn't exhale the high amount of CO2 that was building up in his body. He became acidotic and began to respiratory arrest, but they took off the mask and he started breathing again.
The next patient was on the other side of the size spectrum - a teeny 86yo lady who weighed about 86 pounds. If that. Anyway, she came in because her leg was swollen and painful (=DVT). She has a blood clot that goes all the way from her knee to her hip. While examining her, we noticed a mass in her lower right abdomen LITERALLY the size of a small watermelon. A huge, firm, lumpy mass. When asked if she noticed it she sort of brushed it off like she'd maybe noted something but didn't really think anything of it. She had no other medical problems (because she had never seen a doctor) except this DVT and the fact that she was cachectic from the cancer - she used to be my size. We did a CT scan and it showed a HUGE renal cell carcinoma with mets to the liver and lung. We had to go talk to her today about the diagnosis (we're not "sure" it is cancer without the biopsy so we just told her it was a "mass likely to be cancer"). The hardest part about it was that in her (shared) room, there were EIGHT family members with her, as well as the 5 people on our team. I felt like we were having a town meeting instead of talking about her cancer prognosis.
If that wasn't enough to depress you, the patient I picked up this afternoon almost had me in tears.
She's 28 years old (I already identified with her since she's so young) and just got out of the ICU for carbon monoxide poisoning. Last week she lost power so she and her husband used the kerosene heater. Unfortunately, they both had severe CO poisoning, and it took a while until family found them. She also is a type 1 diabetic, so by the time they found her she had DKA, and the lack of oxygen to her tissues had caused her to have a major heart attack. All at 28 years old. She's off the ventilator but still pretty confused. The worst part of the entire story is that her husband actually died from the poisoning, and no one has told her yet. It's not our medical job to tell her (the family is going to but was at the funeral today) and honestly that kind of psychological stress is more than she needs right now. Even so, it killed me to stand in that room and talk with a girl my age who will never see her husband again.
Even though it's depressing, these patients teach me a lot about life. Like not to take it for granted. I could go to sleep and not wake up tomorrow, and so could anybody. I try to remember to tell my brother "I love you," to give extra big hugs to Chris, and to call my friends and family so they know that I care.
I have to hope that we're making them better. Maybe not today, but maybe someday.
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