Thursday, January 13, 2011

Down The Rabbit Hole

Most people consider hospitals to be places of sanctuary. By definition, a person should expect to be admitted into a hospital with an illness and be discharged later at least as well as, if not better than, before. That is the entire function of a building which houses a large population of healthcare workers and a sizable collection of multimillion dollar medical equipment. But we doctors know better. We have seen too many cases where patients innocently arrive with an innocuous problem and don't leave quite the same way, if they are able to leave at all.

I remember a sad case in preop. While perusing through the patient's massive ICU chart, family members tried to fill me in on everything that happened to her during this admission. The patient was admitted over three months prior with a simple diabetic foot infection. Actually more like a toe infection according to them. What was supposed to be an admission lasting a few days for IV antibiotics turned into a nightmare of multiple vascular surgeries, renal failure requiring hemodialysis, massive decubitus ulcers, respiratory distress necessitating a tracheostomy, altered mental status, constant IV sedation, isolation precautions for hospital acquired infections, and on and on. The family members understandably were bewildered by how quickly the patient had deteriorated to practically a stranger they no longer recognized.

"How could this happen? Will she ever be the same again?" they asked me in vain. I tried to be empathetic and reassuring. I explained that once the human body starts healing it can be amazing how well it returns to its previous state. Maybe this one last operation will start her on the road to a healthy recovery. I knew that was something they needed to hear but deep down I recognized that this would be a very long and arduous course for the patient. With all the medications, infections, organ damage, and prolonged sedation, the odds are against her for a complete recovery. She will most likely be discharged one day, maybe even back to her own house. But she will probably never be the same again, physically or mentally. There will always be a scar left behind from the side effects of modern medicine. With an encouraging smile, I asked them to keep their hopes up and pray for a good outcome. We then wheeled the patient into the operating room.

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