A very sad case

Edworthy, John

It was a routine day, a regular office. I picked up the chart and glanced at the nurses note which read "fever and cough". This was a young, healthy, 27 year old teacher whom I had known for 10 years. This was likely going to be a quick check.

When I entered the room I immediately knew that this was not "the flu". Doug was clearly short of breath and in real distress. He looked clammy and diaphoretic. A one minute exam showed very poor air entry to his left lung, almost no expansion and marked dullness. I started him on oxygen immediately and had my nurse call an ambulance. He was taken to the emergency dept and immediately seen by the respirologist on call. An hour later he was intubated and being ventilated. He had a chest tube which drained frank pus. He was seen by the infectious disease specialist and started on high doses of broad spectrum antibiotics. He gradually deteriorated over the next three days and died on the fourth day after I had seen him. We were unable to stop the progression of his infection or keep him oxygenated. His blood cultures grew Streptococcus pneumonia.

When I reviewed his history I found that he had been ill for a week before I had seen him. He had been to the emergency department twice, examined and told he had "the flu" and was given advice for symptomatic treatment. The day before I saw him he had been in to my office and seen one of my colleagues, complaining of abdominal pain and fever. My colleague had noted the history of the previous visits to the emergency departments and recorded a full history and exam, including an exam of his chest which noted good air entry into both lungs.

The day after Doug died I sat with his mother and his brother, both my patients for over 10 years, in my office. I had seen them during ICU visits at the hospital. How could this happen to a healthy, strong twenty seven year old man? How could he seek medical attention three times in a week and then die of an infection that should respond to simple penicillin? If the emergency physician and given him a $5 prescription for Amoxil a week earlier would Doug still be alive? How could my colleague have "missed it" the day before? Surely there were signs that were missed?

It is very difficult to offer comfort to a family when you are also distraught. How can you answer these questions when, at this point, their greatest emotion is anger. I offered my sympathies, offered any ongoing help I could. I tried to explain the nature of the illness and offered to see them again to discuss it.

Doug's mother and brother clearly stated to me that they could not see me again as I was a constant reminder of their tragedy and that they no longer had confidence in me or my colleagues. That was the last time I saw any member of this family.

In this profession you are given the privilege to participate in the most meaningful moments in peoples' lives. Births, deaths, personal crisis. Sometimes you are richly emotionally rewarded. Sometimes you have to be ready to accept that, in spite of your best intentions, you may be a bitter disappointment to a patient and have to suffer their anger and your own self doubts.

Theme: Health Care Delivery | Prestation des soins de santé

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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