Perfusion of Prescriptions: A Patient Story

#CardiologyClinic

The cardiology clinic usually isn't the place for extreme cases or dangerous situations. Most of the time I shadowed regular check-ups and annual visits where the goal was to simply assess heart health. This was an unusual case, however, in which the doctor probably saved the patient's life due to accidental drug usage.

History

Patient A was an older caucasian male struggling with weight issues. Almost 6 months ago, he was at 320 pounds and was taken to the Emergency Room after he collapsed at his home. He essentially had heart failure and underwent a Cardiac catheterization, or when a small tube is guided through a blood vessel to gauge heart function. He also underwent back surgery in which his oxygen levels went dangerously low. His pulmonary function test (a test to gauge oxygen capacity) suggested that his lungs we weak. Collectively, all the doctors advised him strongly to start losing weight as his body wasn't able to handle the pressure.

The Examination

A entered the cardiology clinic now at 280 pounds and wheelchair restricted. He had a nasal cannula (a lightweight tube that pushes oxygen into two prongs attached to the nostrils) for his low oxygen levels and swollen feet and legs. The chief complaint in the situation was rather unclear, but Doc tried to understand and listen to everything A and his wife were explaining out loud.

The wife started crying as she began her story. As she explained the heart failure, she said that A started going to therapy to lose weight. The weight did go down to 250 pounds but then started rising to 265 then to 280. It seems that A's weight wasn't improving despite their efforts. Furthermore, she explained the hardships that A had to go through during his examinations and testing. A fell four more times in the hospital. At the local Florida hospital where he was kept, he was nearly given 1 test an hour, which devastated the wife. The wife also explained the struggles they faced at home. They have installed a special restroom for A as well as a hospital bed to move him around. The wife is the one trying to lift him in and out of bed, and the Doctor explained that she needs to stop before she hurts herself in the process.

The Doc, noticing the swollen feet, asked which medications is A currently taking. At that moment, the wife opened a duffle bag full of nearly 20 different prescription medications. To be honest, I had never seen that much medication held by a patient. At first, I was amazed that the wife was able to keep track of all the meds, but soon the truth started to come out.

The Doc asked the wife to start naming the medications. After about three were listed, the wife named another bottle with the same medication as the first bottle. The same pattern started to occur with many medications duplicated or triplicated and the wife was completely unaware of the situation. I could see the tears streaming from the wife's eyes as the doctor explained that he shouldn't be taking all of these simultaneously. With every hospital and clinic visit A had to make, they prescribed drugs repeatedly. The wife was simply following her instructions but the no-one ever told her when to stop. The swollen feet and ankles were most likely caused by an increased amount of Losartan, a blood pressure drug, that A was taking repetitively.

At this point, the doctor took nearly 30 minutes going one by one to sort through each medication. I noticed the patient thanking the doctor numerous times. A had been a long-time patient of the doctor and knew that he would do the right thing despite all these other bigger hospitals and organizations.

Doc's Thoughts and Treatment

At the moment, the doctor adjusted all the medications that A was taking, writing down everything for the wife to understand as well. As far as patient A's health, the doctor said "I can give him ten tests, but how is that going to help?" At this point the patient was already on a 1000 calorie-a-day diet, losing 4 pounds a week with dieting. There wasn't anything more to squeeze out. Through the Echo, the doctor noticed some fluid in the lungs and advised me to see a pulmonologist. He was also advised to get a blood test afterward to check kidney function.

Afterward, the doctor spoke to me privately about the situation. He explained that he had never seen that many medications with a patient before and felt appalled by the medical system at that moment. The American system, as he explained, tends to treat symptoms rather than actual the actual cause of the issue. Furthermore, the doctor told me that patient A's condition would likely not get much better as he was already rather old and his body was unable to accept the changes even if A wanted to.

My Final Thoughts

This case doesn't have a happy ending as of right now. Realistically, I probably won't see patient A again. I wanted to share this story with all of you to highlight the variety of issues that comes with being a doctor. It's not all about the medical knowledge and declaring tests, it's about understanding and empathizing with the patient. The emotions conveyed in that examination room will never leave my memory.