It’s been a while since I stopped in here, I know. It’s because I’ve been in the ICU, on the night shift. It’s amazing how sick our patients are, and how young. I did my last ICU shift at the VA hospital, and most of my patients were in their 60s-80s.
This one is different. I’m at the county hospital, and most of my patients this month are under 50. Three of them are in their 20s. And a lot of them are not going to make it, for various reasons.
We had a real kick in the head about two nights ago: a 46 year old pastor shows up into the emergency room, dragged in by his wife, practically kicking and screaming. He has no past medical history and has never been sick. (Please read this as: he has not been to see a doctor for over 20 years.) His wife reports that he has been incredibly thirsty for a very long time, and he was initially urinating all the time. Then, around Mother’s Day, he stopped urinating entirely. The wife forced him to come to the emergency room that day because he had started “acting funny”.
We found this man to be in florid diabetic ketoacidosis (a potentially dangerous complication of uncontrolled diabetes). Despite our best efforts, he crashed and burned right in front of our eyes. This was the first code that I ran as the primary leader, with my senior backing me up. We never got vitals back. He died only hours after he first presented to the emergency room.
This man was 46 years old. FORTY. SIX.
WAY too young to die. And you know what? He didn’t have to. He did NOT have to die. All he had to do was see a %$&^ing doctor, who would have diagnosed him with diabetes years ago and would have managed it hopefully well enough that he’d never reach such a critical condition. When he arrived at our doorstep, his blood sugar was at a level of 1184 (normal values run from 70-110). His kidneys had shut down weeks ago, and his electrolytes were so out of whack that we couldn’t correct them fast enough. He died with a breathing tube down his throat and with a terrified-looking medical student throwing all of her weight onto his sternum over and over, trying desperately to squeeze enough blood out of his heart through his ribs to keep the perfusion to his brain while we pumped him full of drugs to try and restart it. (We did not shock him. He had pulseless electrical activity, which is not a shockable rhythm.) His wife had just stepped out of the room to get a cup of coffee when he coded. His body was cold before her coffee was.
There was no reason that this man should have died like that. No reason at all.
This makes me want to rant. You have been warned.
This dragged-in-by-his-wife-when-he-has-just-reached-the-edge-of-unsalvageability thing is an unbelievably common pattern in men. For some bizarre reason, many men REFUSE to see a doctor until both (a) their spouses force them to and (b) they are nearly dead from whatever disease they’re suffering from. (Or (c) they get erectile dysfunction.***)
Stuff like this just kills me. Would they go 20 years without getting their oil changed, or their car looked over by a mechanic? Yeah, I didn’t think so.
Stuff like this makes my brain want to explode.
There’s no reason that guy should have died.
There’s no damned reason.
What a %^&*ing waste.
***Side note: a teacher at my medical school ungently and non-POC-ly named this phenomenon – a condition in which a patient can be on death’s door, blind, in renal failure, with fingers and toes rotting off, who doesn’t go to see a doctor until he stops being able to achieve an erection – as “dumbass dystrophy”. As much as that term makes me snicker uncomfortably, I think it sucks how many cases I’ve seen already, even this early in my career.