2

May 4, 2009

#1

mrs P was morbidly obese. she couldn’t move much because she was so large, and her hefty weight put so much strain on her back that she had severe osteoarthritis of the spine, so she was always complaining of pain. we gave her all the pain meds that we thought were most appropriate for her, but she rejected them one by one saying she was ‘allergic’. she claimed she was ‘allergic’ to tramadol, oxycontin, morphine, endone etc… so we conceded that in that case, we couldn’t do much for her. she would complain of pain all day long, refuse her meds, refuse physiotherapy, refuse placement in a high-level care home… practically the kind of patient you wish you never had. she was labelled a ‘whinger’ and the doctors tried to get her out of hospital as quickly as possible, because she was overstaying and taking up a bed that should have been given to someone with a more acute illness. then mrs P’s daughter said that her mum was going ‘off’, and we sort of knew it but we didn’t really take her seriously, since she had always been medically stable. then mrs P took a turn for the worse and before we could do anything, she passed away this morning. i asked S why mrs P died. he said “i guess she probably had an infection somewhere that killed her slowly, but it wasn’t investigated thoroughly.” i know it’s not entirely our fault; her prognosis was bleak to begin with but i can’t help but feel like we killed her with our negligence. i am wracked with guilt. she told me that she would rather die first than be put in a nursing home- i guess sometimes when people are devoid of motivation to live, they kind of expire… 😦

 

#2

mrs A re-presented to the emergency department with a 2 day history of confusion and nose bleeds, 3 days after she was discharged for an infective exacerbation of her airways disease and new-onset atrial fibrillation. we started her on warfarin then, an anticoagulant/blood thinner (ie. makes blood less likely to clot but also increases the risk of bleeding). obviously the nosebleeds had to do with the warfarin. her INR was 7.5!!! (normal INR is 1; the higher your INR the more likely you will bleed non-stop). she was really quite delirious and kept complaining about a headache, i told my consultant i was concerned she could have had a subdural haemorrhage, so we got a CT brain. when i looked at the CT scan i gasped. it was the kind of image that makes you go ‘oh my fucking stars’, and i haven’t seen those kind of CT scans since my neurosurg days. it was a massive monster of a tumour in her right temporal and frontal lobes, obviously it had been there for a while but the warfarin we gave her caused the tumour to bleed into her brain. it was grostesque. i f-ing hate brain tumours. we called neurosurg but they weren’t keen to operate on her since she might die on the table cos of her comorbidities like heart failure and airways disease. i had to accept the fact that we couldn’t do anything…. we called her husband and broke the news over the phone (which, btw, is a NO-NO) but we had no other choice. i asked M how mr A took the news, and she told me “he was in tears”. omg. my heart broke.

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