Monday, December 18, 2006

Gimme a break

I admitted a patient one month ago to the hospital as a favor for the on-call team because they were very busy. He had a pneumonia (lung infection). Next day another team took over his care, I was expecting him to get better and leave in a couple of days.

Two weeks after that I was passing by and I found his name on the board. I was surprised he was still in the hopsital.

For a second I was concerned I made a mistake when I admitted him, "Have I missed something?? Did this man have a heart attack that I missed??"

I checked with his nurse.

"Hey why is Mr. X still here, I admitted him 2 weeks ago!"

"Yeah doc something happened in the hospital"


"Do you know nurse Glory doc?"

" Nurse Glory.... yeah I think so" and I was thinking of that chubby nurse who works in that section

" She was changing his IV doc, and she slipped, and she fell real hard doc, real hard"

" Wow! Is she OK"

"Yes she is , but Mr. X is not, she fell down on him doc, poor guy, she broke his hip, he got a DVT now (blood clot) and he can't walk"

"And how's his pneumonia"

"It's good doc, you fixed his lungs doc"

"That's good, now you gotta call someone to fix his hip"


Anonymous said...

Look at the bright side, you did a good job healing his pneumonia!
is he suing the nurse that fell on him?

lubna said...

someone comes to hospital to fix his problems, not to get one free:S

Anonymous said...

El muhim u fixed his lungs, doc :D

Anonymous said...

Waw .. he came with lung infection .. got cured and ended up with a blood clot !
I hate hospitals .. they creep me one way or another .. brrrr ...

Anonymous said...

The real person who treated this patient is Clinical Scientists, or Biomedical Scientists. They take a specimen from him, run several tests then in two days they find the exact bug that caused his Pneumonia and a dozen of possible antibiotics to treat it, then tell his doctor.
If the patient was a little..bit.. old, then even the slightest accidental touch to his/her waist area would've caused it to break!
Some of the older generation simply die if someone bumped into them accidently on the street!

Hareega, this is my first comment on your site, but I've always been following your posts dude :)
Inshallah bashofak someday fi amman.

Anonymous said...

You remind me of J.D the star of the citcom Scrubs.

Anonymous said...

You reming me of J.D, the star of the sitcom Scrubs.

Hareega said...

summer... anyone can treat pneumonias, but the hip fracture.... that kills people

lubna... yes hospitals are really dangerous places

amer... yeah his lungs work now, everything else is shutting down !

tealover, there's a good reason to avoid hospitals, but once you're in one tham make sure your nurse doesn't fall on you

Hey Avery... welcome here, thanx for your comment, the problem with pneumonias is that in 80% of cases you cannot identify the bug, what you've described only works in 20%, so you gotta treat with empirical antibiotics. the good thing is that this usually works.

Oriental blog... thanx for your remark, i hate Scrubs so much it's one of the most stupid shows ever made since the 7th season of 7aret abu 3awad, but thanx for reading

Anonymous said...

Dr Hareega (I wanted to say it!),

I'm sorry to contradict you but, we always identify the causative agents of every Pneumo patient. In details, on records and with a full antibiotics profile.

Hareega said...

man i don't know what is your reference, but when someone has pneumonia there's only a 20% chance of isolating a bug, in 80% of cases you cannot isolate a bug, the blood cultures are negative, the sputum grows normal flora and the patient gets better on whatever you placed him on.

Anonymous said...

I could write an article to reply to you, but I think now I understand what you are talking about.
I am talking about Pneumonia and you are talking about chest infections :)

Anonymous said...

aaaakh ya zalameh.... I'm talking about PNEUMONIA. I don't know what are the chest infections?? I am referring to PNEUMONIA. In 80% of the patients admitted for pneumonias you CANNOT isolate the specific microorganism causing the pneumonia. You can predict it but usualy cannot isolate it. If he's 20 yrs old coming with a walking pneumonia you can predict it's Mycoplasma but it can very much be pneumococcus. If he's itubated in the ICU with a post-obstructive pneumonia you can predict it's Pseudomonas but it can be Legionella or five or six other bugs. In any case, you can isolate the MO in only 20% in the clinical setting, ya3ni 1 out of 5 only. In research settings the chance of getting the bug is 60% but that is reasearch setting which don't apply to almost all hospitals in the US and Jordan, so in real life it is 20%.
That's not my opinion, that's what has been documented. I'll be happy to steal some articles about that and email them to you they are quite an interesting read.

Anonymous said...

Ya Hareega, The common pathogens important to report in the bacterial respiratory diseases laboratory are usually Haemophilus infuenza, Moraxella catarrhalis and Streptococcus pnemonia. They are only reported when the level of growth is heavy and exceeds that of the normal flora by one quadrant of the plate out upon culturing.

The reporting out of sensitivities to antibiotics for these pathogens and others is also done after an automated suppression of most of the results so that the doctor.. you.. does not know the extra antibiotics unless the consultant decides to release them.

The detection of less important bacterial pathogens is also supressed and treatment is always reccommended using regular antibiotics.

Viral causative agents of Pneumonia are also identified if the patient was not responsive to treatment.

If you were to have a CF patient then it would be totally different and every single POSSIBLE bacterial pathogen will be found, isolated and profiled in details.

It is true that pathogens are not isolated or totally reported out from pneumonia patients' specimens, but don't you think that me and you KNOWING THEIR NAMES means that they were or are isolated IF NEEDED?!

Unless it was a Viral Pathogen, the patient will improve from introduction of antibiotics.

To rephrase it: We always identify the causative agents of every pneumonia patient, in details, on records and with a full profile.

Hareega, we also predict pattern of future possible causative agents and the mutational trend of viral resp pathogens. ie not only do we know what we have but what we might get in the future.

Now dr hareega, let's stay focused on the joys of blogging. I am sorry if I stimulated your doctoral senses when I contradicted you point of view of isolation of pathogens from pneumonia patients. I had mine.