MEDICAL LEARNING 1

 

 

 

 

CLINICAL CASE NUMBER 1

 

 


 
 

 M.D(Med),D.O.I.H,F.I.A.E,D.H.A,F.A.I.M.P(Cardiology)

Senior Cardio-Metabolic Physician

Senior Echocardiography Trainer

Cont.: 8605657755

Mrs Manjusha (name changed) aged 86 years referred to me by her close relative one year back. The lady has been sleeping in various hospitals for the  last 90 days. Feeling very sick with breathlessness, palpitations, weight loss, chest pain, nausea and vomiting, constipation and urine infections. She had with her a variety of diagnosis from depression to congestive cardiac failure.

As I examined her I could clearly see an emaciated dehydrated old lady, needing support to move a few steps. Tachycardia with a BP of 160/90. Not interested even to cooperate with medical examination. Grunting will pain over every part of the body and waiting for the call from God. 

   She had a pile of tests and investigations and admission-discharges with frightening diagnosis. I did take my time to get her cooperation and created my notes which showed 14 medical problems and the last one saying senile dementia.

          The most unwanted question from the relatives ….doctor  how many days she will survive. We are tired and are here because our relatives insisted that they visit me. She had already consumed loads of antibiotics and other drugs. There was not a single vein available for IV fluids as they were all blocked with a large number of pricks.

           Well, I began my examination forcibly by offering her a sweet smile...gentle touch....soft but caring voice and no further tests and investigations. Assuring her fully well that she does not have to be admitted. The family was convinced that she needs to be with her family and not away from the family in hospitals and ICU setup.

           No tests and admission. Means no further expense and together whole family was very happy. I did manage to get her IV and give her the fluids and vit C with necessary replacement of calcium, magnesium, potassium and other electrolytes which I could understand from the pile of reports she already had. She was fresh, smiling and with a lot of energy as I sent her home after 4 hours.

  The most important part was I created a will to survive and the lady went home and came religiously for the simple drips for the next 4 days. Ever since she has been seeing me every month and to the happy surprise of all her relatives she is leading a very healthy life.

            Today when I was collecting her history, she surprised all of us when she unconsciously said her age was 25 years.

What has worked on her are not the drugs but a will to live and a will to be happy with life. This is life my friends. You need the right diagnosis and right medicines to treat, but you need to create the will to survive. Making the patient do the host of investigations and frequent painful hospitalizations especially when they cannot afford puts them into depression and a loss of will to survive. At this stage you can do nothing.

       There has to be pleasure and hope for any serious person to recover from sickness.


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