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Explore This IssueFebruary 2018
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4 Patients in 4 Weeks
Baltimore is a little over two hours away from Richmond, Va., by car. I know this now because I recently drove to Richmond to attend a memorial service.
I drove in silence. Music made me sleepy, and I could not bear to listen to another iteration of how we are narrowly escaping disaster in any number of geopolitical areas, so I turned the radio off. In the quiet, it occurred to me that she was the fourth patient I had lost in four weeks. I hope not to best that record any time soon.
Two were patients I had cared for while attending on our inpatient consult service. They were, therefore, not “mine” in the way that physicians think of ownership. The first was a patient with interstitial lung disease who presented with either progressive fibrosis or an opportunistic infection—we still don’t know the root cause of his decline. When I met him, I really did not understand why my colleagues in pulmonary medicine were not more sanguine; he was ill, but he was in good spirits and was well enough to crack jokes about how the hospitalization had conveniently gotten him out of his wife’s annual pilgrimage to Chicago’s Magnificent Mile. A week later, I had started to see what my colleagues had already seen, and I watched, helpless, as he slowly suffocated to death.
The second patient had recently been diagnosed by a colleague as having scleroderma. For some patients, this might mean cold fingers and a touch of indigestion. For this patient, the disease spread through her body like wildfire, within months encasing her skin and her gut in unyielding fibrosis. The latter was the real problem; her daughter reported that everything—medications, food—sat in her stomach for hours, unmoving. There is a short window of opportunity during which a patient may leave the hospital, unscathed by our good intentions. This patient missed that window, and despite her unusual diagnosis, the cause of her death was rather mundane. If I am being honest, the situation was more complicated than that: The patient never really adjusted to her diagnosis of scleroderma and was deeply, profoundly depressed. If I were reviewing her hospitalization objectively, I could state the cause of death with great certainty; having been there at the time, I can’t help but wonder if she died of a broken heart.