EPTFirst of all, let me thank you guys for featuring my blog "A doctor with a broken voice, and dying well" in Pony Tales #7 central pages. You sure made me blush. It's an honor I was not expecting, so I really thank you all for your kind stars and the people involved in making the e-zine for thinking my blog post had cut the mustard to be in it. <3
I bring you another tale. This story is about a case I attended 3 days ago.
My patient was a 85 years old lady. Mother of 5 children, all grown up now of course; 3 men and 2 women. She had diabetes and had high blood pressure. Her husband passed away 10 years ago and since, she stopped taking her medications and went away into the far countryside to spend some time alone.
A few weeks ago, her elder son took her from the countryside into his house... A little closer to my town, but still in the countryside. Yeah, as you've already figured out, this town is pretty much surrounded by agricultural farms and bovine raising farms. He had NO IDEA of his mother's medical history until he found a little "patient's notebook" with citation schedules and her treatment.
10 days ago, she began having hallucinations. Then complaining about temporarely losing sight or seeing "flying lights". And finally, she had seizures.
That's when her son called to our family health centre and asked for a house visit into the countryside.
The next day, I drove 20 miles and found his house. He is a peasant in one of the largest bovine farms around here. The house was small, but cozy. Lacking in luxuries, since peasants around here aren't generally well payed. It was a poor house. But humble and full of that unexplicable human warmth, none the less.
He led me into his mother's room. She was resting in a small bed, very pale. I said hello, but she did not turn to look at me. Instead she was staring into the infinity, torwards the ceiling. She said hello. I then politely explained that I was a doctor who came to visit her because her son was worried for her health, because he didn't know her medical history.
The old lady was absolutely dissoriented. She thought we were in another town. That it was 1948. That she knew me from a long time ago.
I begin controlling her vitals. She had a very strong pulse, regular, at around 60 beats per minute.
Sat was at around 90%. Strange...
Blood pressure...
Wait, what? -I look at the blood pressure gauge in disbelief. I take it again.
This can't be... What the hell?
Her BP was at a scarcely believeable 250/140 mmHg.
That is very, extremely, SEVERELY FUCKING HIGH.
Normal BP for a regular adult is hovering @ [90/60 - 140/90] mmHg.
But the old lady had other issues.
Took my stethoscope and listened to her heart and lungs.
Lungs were filled up with liquid. Pulmonary oedema.
And then, without any warning, she begun seizing again. Full tonic-clonic generalized convulsions. I push an amp of Diazepam IM. Seizing stops. Then inmediately call the ambulance.
They get there in about 25 minutes. I intubate the patient and push an IV amp of Furosemide.
She seizes again. Another amp of Diazepam. Seizing stops.
A severe hypertensive emergency. We needed an infusion pump with to give her IV antihypertensive meds.
I then recall that her son told me she was losing vision for a few moments, then claiming to see "dancing bright lights"...
We rush back to our hospital to try to stabilize her. She had stopped seizing. Her sat improved to 99% with the intubation and assisted breathing. We just needed to control her blood pressure. There was no IV pump equipment in the ambulance. We had to get back to the ER...
We take an in-route EKG. It was remarkabely normal. Capilar glucose levels were surprisingly good for a lady who had not recieved treatment for her diabetes in over 10 years: 150 mg/dL...
All of the sudden, only 10 minutes after we left her home, the heartrate monitor goes flat. I thought an electrode had come lose. I check the pulse first and ask the EMT to check the electrodes.
No pulse.
Electrodes were fine.
Fuck.
We begin CPR algorythms. The EMT starts the cardiac compressions.
We arrive at the ER.
We rush into it. A colleague and friend of mine is waiting. He takes over the compressions. An IV pump is readily prepared.
Another colleague comes in after the ER's CPR alarm goes off. She takes over the ambu bag and keeps ventilating the patient.
I take an ophtalmoscope and look into her eyes searching for any signs of increased intracranial pressure (ICP). She might also be bleeding into her brain because of the extremeley high blood pressure and her brainstem could have herniatd.
Pupils were reactive. No oedema in the papillae. There didn't seem to be an increase in the ICP.
I took over cardiac compressions. She was still in asystole. Full flatline. Even though we followed the algorythm all the way, thought of every other possibility why she flatlined, asked for quick bloodtests which came back negative... And being performing CPR for over 35 minutes, she was still flatlining.
It was time to call it.
My colleagues look at me. I was atop the old lady, giving her chest compressions.
The attending ER doctor then states... "It's time to let her go."
Nurses let her son go in. My colleague delivers the bad news.
Then my other colleague pronounces the words you never want to hear then you're reanimating a patient.
Time of death?
...Her son puts his hand on my shoulder, eyes weeping, and says "It's ok. You did your best... Her time has come."
It was a quarter past 4 in the evening.
As her son stated, her time had come.
