rounds at heart center

at pedia pulmonology at the philippine heart center, we usually have bedside endorsement rounds before dismissal with the founder of Philippine pulmonology, Dr. De Guia. usually, there are only 8-10 patients for endorsement and it only takes about an hour.

during our rounds in the MICU, there was this one patient whose relatives were waiting for Dr. De Guia. Her case was like any other disease often seen in old age: Atherosclerotic Heart Disease. She was advised Coronary Artery Bypass and Graft. The patient, who said she still wanted to live longer, agreed fully to the procedure. She was 70 years old and she wanted to be able to reach their grand family reunion on december.

However, post-op, she was given meds for maintenance. it included heparin, in which 5-10% of the population may have an adverse affect to the drug and cause Disseminated Intravascular Coagulopathy. unfortunately, she was included in the 5-10%. With DIC as the complication, she later had pneumonia which progressed to sepsis and aggravated her condition. currently, she is hypotensive and in end stage renal disease. the dilemma now facing the consultants is whether she should or should not undergo hemodialysis considering that the patient is hypotensive already, the procedure might further decrease her blood pressure. if hemodialysis is not done, the toxins which she can not excrete from her body through her urine because of kidney failure, will intoxicate her brain causing immediate deterioration.

As i was listening to the 3 consultants in charge of the patient talk to her relatives, i felt sympathy for them. their hospital bill had already amounted to 1.3M excluding professional fees. Even more depressing was that, they knew that there was only little hope for the patients' recovery. it was then that they decided to sign a "Do Not Resuscitate" consent form. And as i watched them cry and summon their strength to talk to the consultants, i felt sad. i looked at my seniors and they all had the same poker face expression. how sad is that?

i know that in my profession that there will be more cases like these(if ever i do take up IM). part of me wants to become emotionless in times like these but a part of me also can't control what i should be feeling. it's just so tough...

i should've become a bloody astronaut =p