Friday, August 7, 2009

Life saving procedure

It isn't every day where I do something medically that makes the difference between life or death in a patient, but today I got to. Johnnah came yesterday complaining of some cough, shortness of breath, fevers, weakness for about 4 wks. On CXR he had a huge heart, which I didn't expect in someone his age (20-30 yo) who didn't have a heart murmur. I did an ultrasound and confirmed my suspicion that he had a pericardial effusion (fluid around his heart). I wanted him to be admitted, but he said he couldn't, he wasn't ready, but he would come back in the morning. He was stable and so I let him go home. I was discussing this case with the 2 medical students who are here and they both asked me if I was going to tap the fluid in his heart, and I told them both "No." I proceeded to explain the risks of doing the pericardiocentesis, which includes death, and told them that unless he developed cardiac tamponade, I did not need to tap the fluid. I explained that in effusions that develop over a period of time, they often are able to compensate for the fluid, and don't get to the point of tamponade. (Tamponade is where the fluid around the heart compresses the heart in such a way that it is unable to pump and fill as it normally should, which is life threatening.) I assured them that simply treating him with TB meds would resolve his effusion, like it did in lots of other folks we have seen.
So today, Johnnah comes back, but it was obvious he got a lot worse since I saw him yesterday afternoon. He couldn't sleep or lay flat, was very short of breath, and barely able to talk to me. His had a fast heart rate, with faint pulses, and his blood pressure was low. I let him go home yesterday because he was stable and didn't have any signs of cardiac tamponade, but today was much different.
We don't do pericardiocentesis (sticking a needle under the sternum into the fluid around the heart to drain it) that often here. Previously some of the docs have had patients die, so we only do it when the patient may die without it. That was the case I was facing with Johnnah. I explained to him that there was a chance that he could die if I did this procedure, but there was a greater chance of him dying if I didn't do it. He said he trusted me and to go ahead. In the time it took us to set up to do the procedure, he deteriorated even more. Praise God, after having a few minor setbacks, I was able to drain off about 400cc of blood tinged fluid from around his heart, and Johnnah, very quickly, was doing much better. Later in the day, I went to check on him and found that he wasn't in his bed, but was outside somewhere. This was reassuring that he was doing well and would live to see another day. I shared with him about Christ, and he isn't a believer. I told Him God saved his life and pray that God would give him many more days, and Johnnah would come to follow Him.