Playing Doctor

Initial Visit?

Wednesday, March 2

Uncynical Wednesdays:
Doctor Erik’s Science Project

Hour five through seventy

Since making it to the ICU the girl has been in and out of consciousness, groggy, then asleep, then groggy and moaning, but this morning she’s out. She’s no longer protecting her airway and needs to be intubated.

Yesterday, when we delivered her dead fetus, we’d hoped that doing so would lessen the stress on her body, that she’d start to improve. But she has worsened instead.

I try to call her husband to tell him about what’s going on. But the person answering the phone tells me he’s at work and cannot be reached.

“He needs to be reached,” I said. I had already identified myself, “Now.”

“Is everything okay?” the person asked, crying.

I typically defer on this question, this time I said, “No, its not. He needs to call me.”

By the time he called back, she was intubated.

I explain to him that the liver failure was fulminant. A word as ominous as it sounds. Her liver was so badly damaged that it was not clearing the toxins from her body and her mental status was continuing to deteriorate. This could signal that her liver was on a downward slope toward rapid destruction and might require a liver transplant.

The one good sign we had was that her liver enzymes were returning to normal, but there was debate among the physicians.

Enzymes can return to normal for two reasons. Either the liver damage is resolving or it has simply burnt itself out. I argued the former, pointing to other labs that did not suggest a burnt out liver: her coagulation studies were only mildly elevated. But the other physicians on the team felt that it was simply too early to see the effects in the coags. That the mental status was worsening supported their interpretation.

I continued to argue with the team against transplant. If she could make it through this without one, she would live a lot longer than with someone else’s liver, which would require her to take a lifetime of complicated and potentially hazardous drugs.

“This woman isn’t competent enough to handle Tylenol for Christ’s sake; can you imagine what she’d do with immunosuppressants?”

But I called the transplant team and presented the case, explained the other physicians concerns as well as my own interpretation of the labs. The transplant surgeon and I decided to keep her where she was for now. We would continue monitoring her and inform them of any changes.

It was a busy day for me. But thankfully, by the next morning she was doing better. The coags not only were not worsening, they were improving. The liver had not, in fact, burnt out. It was recovering.

The day after that we were able to extubate her, and return her to the OB/GYN floor.

I recommended a Hepatitis Vaccine series in the future and a psychiatric consult in the present.

The funny thing is that she was mostly unconscious for her stay in the ICU, so though I had delivered her dead baby, kept her alive and was her advocate in allowing her to keep her own liver, if we ran into each other on the street, she wouldn’t recognize me.

Her entire extended family would know me. I had held their hands and handed them tissues as they sobbed in fear and mourning.

But she would not.

I am just another face in the crowd.


Blogger dan writes:

Wow. Leave it to a doctor to put things in perspective. All three parts of that story were both sad and maddening. "It's probably for the best"??!? Man you got remarkable restraint. No wonder doctors get paid so much. They couldn't pay me enough to have to deal with that kind of situation. But you're like a secret superhero and stuff. Um, I posted about Tony Danza falling down today. Not quite as thrilling.


Blogger hot babe writes:

Dan's right. This makes my petty fight with the manager over the Kate Spade garment bag, the cute guy I almost attacked & my mocking a classmate that works for a company trying to help the poor men with ED seem really pathetic. I feel so in adequate. I'm gonna go home & put on my tiara...


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