I went into the room to update the woman about her elderly mother. Her critically Ill mother laying next to us. Ms. Zarova lived out of town in New Jersey, and recently had an acute illness called myxedema coma. She had improved somewhat, but her daughter and son in law thought she was getting worse in the rehab home. So the previous day the son-in-low had flown to New Jersey and hastily flew her to Dallas so she could be under their supervision.
This evening she had become very unresponsive, moaning, and couldn’t provide much of a history. “Ms. Zarova!” I shook the lady. She didn’t really shake back. She was only sixty-three but looked about twenty years older. I stepped and watched her breathe, checked her pulse. Good, she’s alive. You couldn’t tell just by looking at her. I glanced up at the monitor as the nurses were hooking her up and getting her vitals, and they were surprisingly well except for her dangerously low blood pressure.
“Let’s get a line and start some fluids,” I ordered the nurses. I stepped out and got some more history from the family, and went to the computer to order some blood and urine tests as well as a CT of her head. Who knows if she had fallen and hit her head? She couldn’t argue one way or another.
I came back into the room about twenty minutes later after having seen several more patients, and the nurses were still working on the IV. “She’s too dry and her veins keep rolling,” one of the nurses, Ellen, said out loud clearly exasperatedly. “I’ll grab Brian and Veronica,” she added, “and see if they can get one.” I agreed, and her vitals hadn’t changed acutely so I left them alone to get IV access so we could obtain our tests and hydrate this very dry and sick looking lady.
Twenty more minutes passed—still no IV access, so I rolled up my white coat sleeves and started too look at her neck. I was going to attempt an external jugular, or EJ line. I prepped her skin and saw the big fat vein popping out at me. “This’ll be easy, guys, I got this.” I poked the vein, but no blood would flash into the tube. I tried a couple of more times but still no go. She was too dry, and her veins would collapse as soon as they were poked, and not give us the blood we wanted. That was probably due to her severe dehydration. The family had added that she hadn’t eaten or drank anything in the past 48 hours.
After an hour one of the nurses finally got an IV, and drew the tests, and about another half hour from this the tests started coming back: kidney failure due to dehydration, pneumonia, heart attack. All at once.
I informed the daughter and son-in-law, “She has three separate organs failing, but now that she’s receiving fluids and medicines she is more stable,” I told the daughter. The fluids will help perfuse her organs and improve her kidney and heart function…”
“Thank God” she said.
“But it might worsen her breathing as her lungs fill with fluid, in which case I would have to put a breathing tube to help her breathe. A moment passes, she tears up and walks out of the room.
A few minutes later I walk back into the room to update the family on some more results and my plan, and I ask if they have any further questions.
“No, thank you. I do have a couple of other questions, if that’s okay. Can you tell me why I have a sore throat and a cough?” the daughter asks. I look up at the nurse, bewildered.
“She just checked in, too, doctor,” the nurse informed me.
“My nose is so very congested, too. Do you think I need some antibiotics?” Five minutes earlier we were discussing her mothers perilous condition.
“No,” I responded. I pressed on her lymph nodes and looked at her throat. “Frankly I think you have a cold.” I couldn’t believe I was examining her.
“But I recently tested positive for West Nile Virus, can you check the titer? And maybe swab me for the flu?”
“Not sure what would we do differently. 99% of people with West Nile do great. You seem to be one of them,” I told her. “And same with the flu.”
She shrugged her shoulders, “How about strep throat, or Lyme disease?”
I was frankly mad, now. “No, no, you don’t have either of those.” Seriously? I am having this conversation?!
“You’re sure?” she asked.
“You know,” I informed her, “your own doctor can work you up for your non-emergency issue. Like tomorrow; or next week. You’re in the EMERGENCY room. I’m going to turn my attention to your critically ill mother now.”
–DrMedicineMan
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