Thursday, October 8, 2009

Lazarus raised to life again

In the Bible and in our hospital, Lazarus was brought back to life by Jesus.
I admitted Lazarus about a month ago with fluid around his heart (pericardial) and in his lung (pleural). Given the combination, it seemed most likely he had TB, so we started him on treatment. He wasn't on my side of the medicine ward, so I wasn't following him regularly, but one night I got a phone call from Steph. She was worried he was in cardiac tamponade (the fluid around his heart had gotten to the point where it was compressing his heart and wasn't allowing it pump blood to his body) and was going to die unless we put a needle in him. She hadn't done a pericardiocentesis before and wanted some help. When I got there, Lazarus was close to dying. He had no blood pressure or pulse. If we didn't draw off the fluid, he would die before us. Thankfully, we were able to draw off some fluid, and the Lord saved His life and brought Him back from sure death.
It had been about 4 wks since this life threatening event, and he had been improving, but slowly. On Monday, he wanted me to see him as he was feeling more SOB. I talked with him some and examined him briefly, but left Becky to see him as he was her patient. He looked a little worse than he had, but not too bad. Later that morning, the nurse from the ward came to get me as he was getting worse and Becky was busy in the ER with a patient who was seizing. When I got there he didn't have a blood pressure or pulse and once again was trying to die before me. The ultrasound showed a recurrence of the pericardial effusion, and when I talked to Bill, he agreed I needed to put the needle in his chest to drain off the fluid. We got out about 400cc, it was quite impressive to see this bloody fluid pumping out of his chest with every heart beat. He felt better as the fluid drained off, and the ultrasound confirmed the fluid around his heart was less than before. Once again, he was brought back from near death.
Unfortunately, this fluid, most likely, is a malignant effusion from a cancer. If that is the case, it will come back, and we may need to do this again. I've discussed this with the patient and the family, and they are trusting God with his life. I am thankful that his son Lucas, is very attentive to his care and is always at his bedside helping him. They always greet me each morning and thank me for the work God has done through me. They gave me a bilum last week to say thanks, it was very nice. Pray for Lazarus and Lucas. Pray for God to heal him and to give us wisdom in caring for him.