Wednesday, December 28, 2005

Karl, 47y/o M with chest pain

Karl had been using crack cocaine for years. He grew up in the rough part of town, managed to complete 4th grade before falling in with the wrong crowd. It started small at first, a little shoplifting, a little bullying, which soon became burglary and assault by 16. He started into drugs innocently enough. Marajuana at first, but then crack came to be, and he was hooked, like hundreds of thousands before him.

And he lived day to day, trying to figure out what he could do next in order to get his next fix. Food, family, friends, they all fell to the side while he tried to find the money for another rock. His family could only coddle him so much before he found himself on the street.

He had his first heart attack at age 29 after robbing a house. He scored enough crack to keep him busy for a week, and smoked it all in a day. His chest burned and he couldn't breathe. Some passerby saw him gasping for breath and called the ambulance.

Since then, he'd tried to get his life together. He had a job again, shelving at a supermarket, but it was work nonetheless. He kept clean from crack, as much as he could. But he couldn't help himself at times. He'd do fine for a year, then find himself lying in his apartment, barely functional. Still, he'd try to pick up the pieces and start over.

He found himself in the hospital frequently for chest pain after too much crack, and by the end of his stay he'd leave with a handful of Vicodin. And soon it was more than a handful. And soon, it was percocet, then oxycontin. And he kept away from the crack, but he'd traded one demon for another. And he took more, just to try to forget his life. And he'd find anyone who'd write him a script for something. And he'd pay good money for just a piece of paper with some scribbling on it.

And one day he ran out of Vicodin, and the pharmacists all knew him well, and he hadn't had anything for days. Everything hurt. Everything was pain. And he just wanted something to take it all away. And there was the crack. And Karl was back on the pipe, trying to smoke away his life.

And at the age of 47, Karl had his second heart attack.

Sunday, December 25, 2005

Stacy, 56y/o F with breast CA

Stacy had been having a tumultuous 2 years. She had her routine mammogram, and thought nothing of it until her doctor called her. "Suspicious calcification" were the words he'd used. They'd need to do a biopsy, he'd said. And after some surgeon stuck a needle into her left breast, suddenly, she had cancer. It didn't seem real.

So next came the surgery, where this same surgeon took her whole breast off and cut up her armpit, and she toughed it out. Then came the other breast, and she toughed that out too. And she toughed through the radiation.

And then came the chemo. "Newer, more specific regimens" the oncologist said. "Fewer side effects" he promised. And yet, within days, she was bald and her mouth was full of sores. Sex hurt, and her husband had finally had enough of this. He left without so much as an explanation.

She had told her daughter, who was living with her boyfriend now. Her daughter had moved out on her 18th birthday, and wanted nothing to do with her controlling and overbearing mom. Her daughter was full of attitude, and was done living her parents' dreams. Stacy couldn't blame the girl. They weren't parental role models.

Stacy tried not to tell her about the cancer. No point in worrying her, and after all, they'd cut it all out. The radiation and the chemo, that was just for good measure, hopefully.

But it wasn't. And it didn't work. "Liver metastases" she was told when they started another course of chemo. Then bones. Then the brain. And more chemo. And more surgery. And more chemo. And she got used to wearing hats and throwing up. She even got into basketball, from all the lying in bed she did watching TV.

Her daughter looked after her on chemo days. She'd help her to the couch and get her something to eat. They didn't talk much. Things were so strained, but Stacy appreciated it. Her daughter tried to smile a lot and act cheerful, but it made her as sick as Stacy to see her mother like this. But in spite of all the treatments and surgery, the vomiting and fatigue, Stacy kept going. She didn't feel like a mother anymore. Her daughter seemed more like the mother now.

And only last week, the oncologist was full of hope. The chemo was working. It was a miracle, he'd told her. She was beating the odds. But she only felt worse. She was weak now, unbearably weak. She couldn't walk to the bathroom without gasping for air, and she couldn't breathe lying down. Her legs were all puffy, and the hair was not coming back. she didn't have the strength to eat, or the appetite.

The oncologist wanted to get an echo, he'd said, a fancy ultrasound of her heart, and lying there on the exam table, the ultrasound tech gasped. She called the oncologist and sent Stacy to the ER. "Severe heart failure" was the diagnosis. Her heart wasn't working.

Stacy lay in the ER, waiting to be admitted to the hospital, her heart putting out just enough blood to keep her awake, and answer questions she'd answered a hundred times. History of breast cancer, mastectomy, radiation and chemotherapy, liver and brain metastases. No other medical problems. Vidocin for pain control. Ativan for her nerves. Prozac so she could look in the mirror at her scarred chest and not kill herself.

Stacy asked for her ex-husband. A reconciliation seemed appropriate. But her ex never came. He was terse over the phone. A brief "Hope you feel better" was all he could muster. Hope, hope, hope. The doctors were all so full of hope, but Stacy knew what hope was worth. Her daughter never left her bedside. She held onto Stacy's hand, as if her grip could keep death away.

Stacy died due to severely decompensated heart failure.

Saturday, December 24, 2005

Welcome to HPI

Hi! I made this blog as an outlet for my fiction, which I've been neglecting. Lately, I find myself thinking about my patients, and their lives before coming to the hospital. In medical jargon, the preceding symptoms leading to the encounter between patient and physician is called the HPI, or history of present illness. It's a summary of the time course and symptoms the patient has been experiencing, and guides the physician in diagnosis.

In this case, however, it's a little piece of fiction inspired by my patients. Of course, I should note that none of this is true. The names and descriptions are all changed, and the diagnoses are different. And I've invented all the other details. There's no truth to these posts, so don't read too much into them. If it was true, then I'd get in all kinds of trouble, and the HIPAA police would come and get me.