The young doctor entered the ICU after a long leave and he could not help but notice an obese old lady on ventilator. It had been a week they said. Running through the patient case sheet and investigation reports revealed hardly anything as they were all normal. Under training in general medicine, the young doctor did a detailed systemic examination of the old lady and there was nothing abnormal he could find.
Days passed by, scanning of every body part and biopsy of every possible tissue was done. The old lady had undergone tracheostomy by now and there was hardly any body cavity left unscathed. Where the specialists could not reach a definitive diagnosis, the young doctor had been tasked with routine tapping of fluid that would eventually collect around her lungs, to provide her symptomatic relief while breathing.
As he would regularly arrive in ICU nearing the bed of the old lady and gaze at her, an exquisite conversation would ensue…. the conversation between a not so willing patient and a keen young doctor. This conversation gradually became a monologue of the young doctor where he would just talk endlessly to the old lady while doing the procedure, expecting that maybe someday, there would be a feeble response. It became a usual run-of-the-mill.
Just like other days, the young doctor was on with his procedure of tapping the fluid, when the ECG monitor beeped. The nurse came running and the young doctor gradually pulled the needle out. “The heart rate has fallen” the nurse said, however, the old lady was pretty responsive. The old lady had been in ICU for over a month and such fluctuations would not startle a regular hospital staff now. “Tomorrow…” said the young doctor to the old lady, winding up the equipment.The heart rate returned to normal and the young doctor walked out of the ICU.
An hour later, when the young doctor neared the ICU, he could hear a loud counting… 1,2,3,4…coming straight from the ICU. For any doctor, it means a code blue response is on. CPR was being given to resuscitate the old lady. She had finally surrendered. As it happens with many of ICU geriatric patients, she could not be revived. When the hospital assistants were busy plucking the tubes out of her body, the young doctor stood there staring into nothingness. A bit sad and a bit guilty. Deep down he knew that this was going to be the outcome one day, but he also wished for his monologue to turn into an unlikely dialogue someday.
There always happen to be two facets of curing the patient. Treating the diagnosis and treating the patient. Yes, they are two separate entities for many a times the latter remains out of our sight. The objectivity of the former complements the subjectivity of the latter. And a job of a doctor is incomplete without realising both facets.
We will never know whether we had treated the old lady but she certainly went Undiagnosed!!
