Still Alive. I Am, At Least.

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.

Published in: on June 8, 2011 at 8:11 pm  Comments (17)  

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  1. People don’t want to be told they have to change – their diet, their habits, their ideas. So they don’t go to a doctor who might do all three of those things. Or they’re too afraid of being sick to be told by a doctor that they are.

    I’d written a long list of people I know who have refused to see a doctor about something, or get tested for something, because they didn’t want to have to quit smoking or change their diet. Some have died. Some are including their children in their decision. They’re blind.

    I erased that list because it makes me angry, and because you don’t need to know all the details. But even though I don’t have to deal with the finality of those decisions, I just wanted you to know that I’m just as frustrated and p.o’d.

    Doc, you already know you can’t save everyone. The problem is, you’re in a profession that’s *trained* to save people. That makes it hurt more when you can’t save them. I’m sorry. It sucks. And it’s not your fault.

    • BJ, you’re absolutely right about not wanting to be told to give things up (every time I see someone (particularly a young person) smoking, I just want to scream at them) and about the fear of diagnosis (I had a patient who didn’t come in about her breast cancer until the left side of her chest was a solid mass of tumor).

      It sucks and it’s frustrating.

      But I think the wisest thing about this topic that I’ve ever heard was on an episode of Scrubs: “Newbie, you won’t last long in this profession unless you learn that you can’t save people from themselves.”

      How. Horribly. True.

  2. Maybe this post will help get someone else to the doctor who wouldn’t otherwise go.

    Sending good thoughts your way.

    I know you don’t have a lot of time, but I hope you’re getting what you need to weather the mental and emotional. A run, reading a book for pleasure, some cookies and tea– whatever it is. It’s the kind of strain that sneaks up on you. Take care.

    • Here’s hoping, grumpymartian. That’s really why I ended up posting this, after a long discussion with myself about whether or not it fit with the attitude of the blog (which I started out wanting to keep very positive in tone, but I noticed that recently, I’ve had a lot of not-very-positive stuff to talk about.) But I wondered if any of my readers might possibly be putting something off, or avoiding something, or whatever….and I figured that if even one person was, that this would be worth saying.

      Thanks for the good thoughts, and know that I have a good deal of emotional support from my amazing family and friends. I also have a hammock, and a stack of books beside it, along with a box of dried pineapple.

      My job is hard and frustrating, but I’ve been working toward this my entire life. My mom said I started talking about being a doctor when I was six years old. I am existentially fulfilled. The awfulness of the day-to-day stuff might be sneaking up on me, but the me that it’s sneaking up on is the most satisfied and happy me that I have ever been.

      Thanks for the good wishes!

      • I work in museum collections. A lot of the people who come with donations are either facing end of life planning or are family members of the recently deceased. I do a lot of grief counseling in odd situations. (Not exactly something they prepare you for with an anthropology degree– but I do alright.) I know this is the way of things and I love my job (I get to touch insane historic things– though the 100 year old pessary is something I wish I HADN’T touched) but it still sneaks up on me. I find it helps to give yourself permission for a bit of a freak out, then get back at it. Takes less energy than ignoring it.

        πŸ™‚ hammock, books, and pineapple sounds like just the thing.

  3. I hear ya, Doc. I hear ya.

  4. Thanks for this, Dr. G. That sounds like a sad, painful, difficult thing to go through (though at least you’re not the pastor’s poor wife).

    If you’d like to be distracted by something completely inappropriate to this topic, there’s the fun song “Still Alive” by Jonathan Coulton, used as the credits for the computer game Portal (which I haven’t played–but I think Jonathan Coulton is kinda a genius. You probably already know about him).

    It is a song about evading death, but it’s sung from the point of view of a psychopathic artificial intelligence (I gather), so that’s a little different from what you’re talking about here, I think.

    PS – Posted about this. Trying to spread the word about not dying unnecessarily.

    • Jonathan Coulton is indeed a supergenius. (What’s with all the screaming? You like ponies. You like monkeys.)

      You know, I’ve never played video games. But I have to admit I’m so curious about Portal based on how much people talk about it! I kinda wish I could hear the story without having to bother with the game. πŸ˜€

  5. Oops, forgot the link:

  6. That sucks. I am so sorry that you are in a profession where this is something that you see with such regularity. It is heartbreaking, I know, as well as maddening.

    • Yes. Yes, it is.

      But it’s good that there are people who deal with things like this, and it’s also good to be one of them.

  7. I see this in radiation oncology myself, though it isn’t always just men (though they are better represented, in general). People wait until their tumor has grown to the size of a football and ulcerated the skin before they come in. You see, they had attempted alternative medicines. When they six months of eggplant salve and IV vitamin C prove ineffective, they show up on your doorstep. Then when you do your best to palliate their pain, they scoff and roll their eyes and say, “See, I knew they couldn’t do any better.”

    • Hey! I wanted to say that…
      Never mind. Those people are everywhere. There wasn’t a week in Oncology when we didn’t have at least one (sometimes more) patient who showed up with some devastating disease who was treated by Homeopaths or some other … hmmm… good people who don’t know anything.

  8. Dr. Grasshopper,

    First and most importantly, I hope that your post does convince some people to go see a doctor about that constant thirst. My husband has had type 2 diabetes for over twenty years and is still doing well with oral meds and exercise, plus some of those dreaded diet changes. It is so thoroughly treatable! What a tragedy.

    I also hope you manage to do more writing. “His body was cold before her coffee was.” Oh, Dr G! I’m sick at heart for the cause, but what a wonderful vivid line.

  9. […] if that doesn’t apply to you, well, see previous thoughts on that topic, then get a doctor, and THEN read this […]

  10. Cant eat carbs, cant eat fat, too much protein is bad for you, all thats left is fiber and that just passes right through you. yeah its a wonder that people dont listen anymore.

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