the original title: until death, I also don’t know what on earth is he…
aunt is I met a patient in general internal medicine, 60, female, high fever for two months, the lung inner shadow with low oxygen, complete blood decreases, outside in the hospitals at all levels, and tried a variety of antibiotics, was not to the union.
general this kind of situation, if the monism analysis, our entry point is often infection, tumor, autoimmune disease, such as three large, each assay, image and antibody check is needed to confirm or exception.
patients with unknown etiology
patients admitted to hospital in late may, to rapidly improved after the inspection, we mortified to draw two conclusions: “cannot see through”, “disease is not light.
“cannot see through,” to be honest, I don’t know what the patient is sick.
“disease is not light,” patients state of the whole can be said to be very bad:
type I respiratory failure.
hemoglobin is low, need to continuously maintain blood transfusion;
blood clotting in a great mess, for a time we lose the plasma everyday, patient of fibrinogen was less than 0.5;
for poor physical cooling and all kinds of drug reaction, burned badly, the heart rate of 120 ~ 130 times/min, the blood pressure is 90/60 mmHg, mind went into a state of sleepiness;
all the explosion index table – ferritin peak more than 8000, 140000, LDH of clinical laboratory colleagues to I make a phone call to ask the patient what is ill…
aunt party condition deteriorated, the speed of deterioration in days.
aunt party this disease complicated details of seriously ill people, we will encounter many difficulties.
because the diagnosis is unclear, we can’t do what the other those diagnosed clear, clear the natural course of the patient to predict the shape of the illness, to assess the treatment response, to avoid complications, we can only depend on the condition of close observation and experience.
and this kind of patient, illness suddenly changes may occur at any time, played us off guard and their families. But we can do, also can be to support treatment and symptomatic treatment, the causes of removing treatment is impossible.
the understanding of the patient and family
at such times, whether the family can understand the illness, can follow the doctor’s way of thinking for the present situation to do a reasonable judgment is of vital importance.
to understand the patient condition is very heavy, rapidly changing, they need to be able to understand accept we constantly check blood test, blood transfusion support continuously, to be “never” to accept our condition metasomatic and various consultation, want to have a “big heart” the patient’s condition under the ups and downs, and at the doctor’s a pile of medical terminology listen to understand the seriousness of the matter, make reasonable decision, will face the water can wash the costs keep self-restraint and calm…
to be honest, it’s really hard. Can do such families, are rare.
aunt party daughter did.
she is from Beijing to fight one of ordinary young people, have a mortgage to pay, has children to raise, her only sister farming at home, as a result, almost all of the costs are she undertakes alone.
however, due to the change of mother’s illness, in the face of our conversation repeatedly, but she behaved calm and restraint, rational and do not break tenderness, and can quickly understand the indirect means, we can clearly express their demands and difficulties, to calm and delicate care of mother, theone to say with me “ summer doctor, you were laborious, must pay attention to rest”.
aunt party I also very cute, and my mother is the same age. A dry thin woman, painfully painfully son lay on the bed, every day you say to her what is nodded and agreed to, never ask more, also not going. Private time will quietly asked me: “ summer the doctor can cure not? You said I this disease can’t cure don’t cure, I see her day and night here, and the love…”
I remember I have any changes during the period of hospitalization was done 3 times in a short period of time the patient bone wear, every time I said reason aunt party after hearing daughter immediately said: “ to do, no problem, you’re the boss.” party aunt are drooping head, double eye, then let’s say come on…
experimental treatment, the first connecting
although all say the doctor to the patient are alike, but encounter this kind of patient and family members, I always can’t help but to force yourself to work hard to find a way to pull her a pair of, force yourself doing things better, and better.
cory organized and partial grand rounds, that is my in the three months to hear the discussion of one of the most intense rounds.
predecessors ideas to our action, we crustily skin of head out for half an experimental treatment. Than real life drama, patients it is impossible to like playing in the house, can be in again and again failed after experimental treatment, can also keep the rational and grace.
in reality, you fail once, hard to build a little trust between doctors and will collapse.
and aunt party daughter talk we have to take the treatment, frankly tell her our difficulties and her mother illness difficult place, tell her I can expect the good and bad.
aunt party daughter said: “ summer, doctor I understand what you said, as you come on. Can is a accident of my mother, we tried our best.”
fortunately, patients and we have good luck.
up after treatment, the patient should meet day by day started! Stabilize body temperature gradually returned to normal, vital signs and oxygenation improvement, blood routine and blood coagulation has gradually restored.
aunt party to gradually shake off the oxygen and blood transfusion, and other patient general condition is good, under the hand of his daughter have no matter son walking the walk in the room. Early admission the detonation table indexes also slowly back to close to normal.
hospitalized more than a month after the aunt party finally success was released from the hospital!
to the hospital, I repeatedly told aunt party daughter, as his condition is not very clear, so in the future is likely to encounter difficulties, at the same time our treatment has certain immunosuppressive effect, if fever again to see the doctor right away.
aunt party hospital said: “ summer doctor, why I really thank you for you saying?”
I say: “you have a good to take medicine and have a good follow-up.”
for the first time a week after the follow-up, aunt party state is very good, each index is normal.
condition, repeatedly had
just, the beauty of the world, never pity the aspirations of people.
again after two weeks of follow-up, the attending doctor told me that the aunt party in recent days, feverish condition with a swollen for suppress him to open the chest CT, sulfanilamide, let me watch as a result, if the situation is bad, hurriedly come back ward.
the next day was a Saturday, because I thinking about this, open the doctor’s advice system early in the morning to find the aunt party CT image, when I saw the clouds out of the moment, my in the mind “hitched” : this is out of order, aunt party created serious lung infection!
because there is no empty bed, ward and the attending doctor brief after consulting, I immediately take out a cellular phone to aunt party daughter call: “I am in the summer of the doctor, you listen to me carefully, your mom should be got serious lung infection, you bring her now and previous data, hurriedly to the hospital to, we give you contact care ward in the hospital. You have what things to put down, give her to eat three slices of sulfanilamide, then come back to the hospital, to call me!”
I’ve been itself is a fairly calm man, even the rescue when I also try to calm, his words but I can feel at that time, my voice nervousness is obvious.