Wednesday, September 23, 2009
I recently had a patient in the hospital who was very sick and I thought was going to die from the first day I saw him. He had altered mental status, fever, GI bleed, liver failure, and renal failure. I wasn't really sure what the underlying illness was, but I kept trying to treat the manifestations of his illness as I was trying to connect it all together. He started to improve on day3, so I decided to ask Bill for some help in connecting the pieces, and he did with Weil's disease. Weil's disease is a severe type of leptospirosis, which one gets after coming in contact with infected urine from an animal in one way or another, often an infected water source of some sort. The classic manifestations are altered mental status, hemorrhage, renal and liver failure - all of which my guy had. The books say that Weil's disease carries a high fatality rate, and in my experience it sure does. After the patient got better for about 24 hours, he then got sicker and died. Shortly after this case, I have seen 2 other patients with likely Weil's disease. At least in these cases, Weil's disease was in my differential since I now knew what it was and what it looked like. Unfortunately, the one pt, a young man died about 48 hours after getting admitted. The 3rd pt, seemed like we caught him early and I started him on treatment, hopeful it might work. I was discouraged later in the day when I was told the family wanted to take him home to deal with some issues at home. I went and talked to the family and patient and explained that I am not releasing him, and I really think he will die if they take him home. Later in the day I went up to see if he was still there and he wasn't, the family had taken him home. I don't know what the outcome would have been had he stayed in the hospital, but I would have rather him stay so we could care for him. There are a number of reasons why pts die despite having access to medical care. At times, patients present too late and despite having medicines or surgery that could help them, we just don't have time on our side. At other times, the patients, their families, their customs and beliefs prevent us from helping folks because they won't allow us to, or they remove the patient from the hospital when they are getting care. I don't fully understand this, but a lot of times folks think that there is some unresolved problem at home which is causing the problem. They think that if they are able to take the pt home and resolve it, the patient will then get better without medical care. I try and encourage them to bring the family to the hospital to try and resolve whatever they think needs resolving, or to explain what the illness is that the patient has and how the medicine will help them. Sometimes it works and they stay for treatment, but sometimes it doesn't. Pray that this pt, Andrew, may come back to the hospital before it is too late.