During my well-deserved vacation, I will not have access to the fabulous intertubes. In my absence, I will repost articles that I choose for no other reason than I like them. Thank you for your patience, and expect new posts after December 16th.

The practice of medicine is full of them. Next time you are wondering why your doctor hasn’t given you a straight answer, consider one of my cases. The names have been changed to yada yada…

Mrs. Branson

She is a lovely older woman. Every time she visits me in my office she shows off the latest piece of jewelry her husband has gotten for her. It is of the J.C. Penny variety, and she couldn’t be happier. Unfortunately she suffered from mild mental illness most of her life and as a consequence smoked like crazy. She was finally able to quit, but not before doing quite a bit of damage to her lungs and blood vessels. An unfortunate coincidence has given her a significant inborn immune deficiency to go with her emphysema. She sees me often for recurrent sinus and lung infections. Well, the last time she came to me, I tried her on a different antibiotic as she seemed to be a little resistant to my usual choice for her. My decision had unfortunate consequences–she developed what was probably a horrible allergic reaction to the medication, and was in the intensive care unit for a week. After recovering enough to think about moving on to a rehabilitation facility, she suddenly took ill again. Her blood pressure crashed, her temperature climbed, and she grew a nasty bacteria from just about everywhere.

After her second week-long stay in the ICU, she returned to the regular medical floor. She looked horrible. Her family stayed by her bedside from the moment she entered the hospital (I take care of most of them as well). I received a tearful call from her daughter very early the other morning. The patient was very short of breath and delirious. The family wondered about hospice care.

I’m all for hospice care. Many of my patients have benefited from the comfort that hospice provides at the end of life. But is this the end of her life? Sometimes this is an easy question to answer. Here, it is not. She looks terrible. She feels terrible. She has several horrible diseases. But she could potentially recover. How likely is it? There is no book to consult. There is no expert who knows. I am the expert.

—-

Update: Mrs. Branson took a turn for the worst last night, and I’ve transferred her to the hospice service.

____

Further update: She just passed away, with her family all around.