Monday, August 06, 2007


A brief post here, in between reading about the barbiturates and coming up with new excuses not to read about the barbiturates. And herein an update on the ICU.

When first we spoke of this there were five patients in the ICU who were horribly unwell. Then there were four, now there are two.

Mr Ayre, as stated, left us. He made a brief return one night when I was not there, but we did the same as we did last time (mask on face, antibiotics) and the same thing happened (he became well enough to return to the ward). Mr Ayre's situtation is that he is now in end-stage airways disease, and in the end stages of respiratory disease the intervals between hospitalisations become increasingly short. He moves from the ICU to the general ward to the ICU, home becoming more and more remote. He may not get home again.

Mrs Burns is almost well enough to go to the ward. She is the large, inoffensive woman who had the colonoscopy. The repirator kept her breathing, the chemicals prevented most of the kidney damage, she had four days without surgery recently. Her husband has not left her side.

Mr Wood died. You could almost feel the anger leave the room. It was three in the morning, Dr Fang was downstairs helping with a resus, he died quietly and quickly. His son had apparently been holding out for a miracle, without wishing to sound horribly twee I feel he got one.

Erica Stone has left "AMA", against medical advice, having stayed in hospital for eight days. She was prevented from leaving with the IV line in situ, and arrangements have been made for her to continue the antibiotics for her heart infection, but she is gone.

And Mr Mettle died. He was - and this may not be politic - the one whom we had tried hardest to save. Every ICU consultant, the infectious diseases people, Professor Veoli from the respiratory unit had been there, seen him, clustered around the bed or held hushed conferences in the corridor. Turning up or down the oxygen, adjusting the pressures of air going in and out, thinking of another antibiotic we hadn't tried yet... everything.

But still, there are laws of hysiology, not as clearcut as the laws of physics but in this case as irrevocable. His lung compliance - a measure of how easily your lung inflates, the more easily the better - was the lowest Dr White has ever seen. His white cell count - the white cells are the cells your body releases to fight infection - was so high* people asked about leukaemia. He'd spent a fortnight on adrenaline and noradrenaline, he was starting to get the profound muscle weakness that people who don't move in the ICU get.

I don't know. It seems stupid. You look around you and you see what we've got - magnetic resonance imaging and monoclonal antibodies and artificial kidneys - and you think how come pneumonia still beats us.

Sorry, I don't know how to put that. But it's not cancer, or some horrible AIDS associated phenomenon. It was pneumonia in a vigorously strong young man, who probably didn't go to the doctor from one decade to the next. And we couldn't stop it, and we couldn't slow it, and we never even found out what it was - blood cultures, lung cultures, everything came up clean.

Anyway. Back to the brainstem.
Thanks for listening,

*Seventy two. Our lab says normal is four to eleven point five.


Blogger Camilla said...

I don't know what to say, other than that I feel very sad for these people I don't even know :( It could just be pregnancy hormones turning me into a sook, but actually I think it's more likely because you writing about them made me care what happened to them.


1:54 AM  
Blogger Lizzie said...

Hi Doc, I just found your blog. I like the profiles of your patients and the follow up. I've been reading back thru your archives and am just fascinated! Any thoughts of publishing?

You seem to have lots of experience with methadone for drug addiction. My experience with it has been for chronic pain from sacral nerve damage. The problem is that even at super low doses it causes profuse head and upper chest sweating. Does this abate at higher doses? Did you run into this alot?

1:48 PM  
Blogger Foilwoman said...

Camilla: I've been too self-involved -- I didn't realize you were pregnant. Congratulations! I'm betting Arni is all proud and pleased with himself (as though he did something difficult, hmmm?), and well, let's just let him think that: Good work Arni. When's the due date? Can I start a blog pool? Actually four blog pools: (1) birth date; (2) weight; (3) length; and (4) gender (if not already known). I know I'm crass. Congratulations again, in case I wasn't clear on that. Don't listen to any of the scare stories: parenthood is the most fun ever. Also the most exhausting and most scary, but the most worthwhile thing I've ever done. Okay, so I haven't done much worthwhile, but anyway . . . Congratulations again.

BJ: Sorry for hijacking your comments. I've seen a lovely photo of you with a lightbulb in your mouth, courtesy of His Eminence, Benedict XVI. I'm still broke, so for a small fee* I could be persuaded not to illustrate my blog with your Uncle Fester imitation. And may I say you look lovely in that fluorescent hue?

*Joke. I preserve my anonymity and protect that of other bloggers.

1:02 PM  
Blogger Camilla said...

Thank you, Foilwoman! :D We're both very pleased and proud of ourselves, and very much looking forward to meeting our Wee Beastie. The due date is 22 October, so we're rapidly getting closer! Feel free to start up a blog pool about anything you like, but you might want to replace the gender one with hair colour or number of tentacles or something (we already know it's a boy :P ).

So far I'm maintaining equanimity in the face of any and all horror stories (what is it with people trying to freak out expectant mothers anyway??) and turning instead to good examples of parenthood for ideas (you're one of them, btw - I love how you write about your girls :D ).

Apologies also to BJ for momentarily hijacking his blog comments - if you're interested, Planet Baby updates can be found at my LJ (The Rat Haven in BJ's blogroll).


5:52 PM  
Blogger Foilwoman said...

I thought I might get a, oh I don't know, response out of BJ based on my intemperate (but completely unbelievable) threat, but know. So let's hijack away. I will be checking out Planet Baby, and will start a pool. Hee. Remember: people who get bored by stories of the wonder that is your child? Well, why would you want to talk to them anyway? It's amazing, wonderful, and in the face of that you wonder about all the metaphysical "Is there a God" handwringing that goes on.

1:32 AM  

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