May 25, 2010


Patients take patience. On any day, interaction with a high number of people can be trying, especially for an introverted personality like myself. But patients are uniquely frustrating in that many of their disease processes are self-induced. This becomes difficult to manage in an outpatient setting, where patients have the capability of making lifestyle choices. By the time they reach inpatient status, the problems are sometimes beyond repair. I've had many such cases this week in the ICU, and have been struck by how preventable they all could have been.
Besides the typical obesity/hypertension leading to heart disease, and smoking leading to pneumonia and pulmonary complications, there has been some interesting cases of causality casualties. Here are a few examples from my last couple days:

  • A young man so obese that the weight of his chest wall compressed his own lungs to where he couldn't properly oxygenate his blood. He needed a tracheostomy and a gastric tube and placement in a long-term care facility to lose enough weight to be weaned off of the trach.
  • Two teenagers with multiple gunshot wounds to the chest following a gang fight.
  • A Jehovah's Witness dying from complications of low hemoglobin post-surgery. She would walk out of the ICU if given a few units of blood, but instead will die within a day or so from heart failure from her steadily dropping hemoglobin.
  • A patient with severe aortic stenosis who declined a valve replacement for years. Now she has consented to the surgery, but her heart is four times a normal size from the pressure exerted on it from the stenosed valve, which makes her a poor surgical candidate. Even if she were to survive the operation, her heart is too badly damaged to expect any change in prognosis.
  • A young mother, brain-dead from an overdose of cocaine, meth, marijuana, and other drugs. She was brought in after crashing her car with her baby daughter in the backseat.
  • A woman who wrote an alternative-medicine book on radiation poisoning, who failed to follow up with her doctor after he told her the treatment for her lung mass was radiation therapy. Now she is in the ICU with a lung completely filled with tumor and metastases to the liver and brain, causing intracranial bleeding. She didn't even want the CT scan that yielded that information. She died a few hours later, only 58 years old.
It takes a lot of patience to manage these situations; to explain to a family member that choices their loved one has made has caused irreversible damage. Families sometimes displace anger over the uncontrollable nature of the situation onto the doctor, and that takes a lot of patience to work through. You force yourself to be patient and thoughtful with the treatment, because it is unmotivating to try to heal someone who made such damaging decisions. You try to be patient and kind with yourself, acknowledging the frustration and discouragement that comes with an easily preventable death.

One thing I am learning quickly upon entering doctorhood...patients require patience.

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