Thread by @Medical_Nemesis

Ispired by randomness and suddenness.

Cases of sudden afflictions and deaths in medicine abound. I always believe in them, terrified at the thought I can wake up to find my ears fell off.

Ears don’t fall off. /1

https://twitter.com/angrycardio/status/1323805069238820869

What brought you to the hospital?
I can barely make out words of a woman in her late 70’s. She is weak. Doesn’t eat. She has a leaking feeding tube in her stomach to make up for her lack of appetite.
I hear a story of a pancreatic cyst removal. The lady asserts she’s cured /2

Judging by the fact her pancreas and spleen were taken out, she is probably in denial. Not uncommon to misunderstand medical communication. Her story makes no sense but I shut up, tell her I will review her records and come back to tell her what happened. /3

I barely scratch the surface of her medical record when I get a call from the Covid wardens that her frantic son is downstairs. His mom called and said she was dying. We are locked down but I make my way downstairs to talk to the guy. /4

The son collaborates his mom’s story. Healthy lawn mowing older Southern lady goes in for routine pancreatic cyst removal. Five total surgeries later and two organs missing she is struggling for life. /5

Son blames the surgeon. I cannot be sure. Surgeries are unpredictable.

Have you learned anything from this story? I ask of the man

I never want to go to the hospital.

We derive different meanings from the same situation. /6

I go back to talk to the patient. How was your cyst discovered? On a scan. Why were you scanned? She didn’t know.

Upon more probing I find out she came to the doctor with pain in her stomach. /7

Back to history reading I go. Chronic pancreatitis. 20 years.

Back to patient. Oh I’ve had it for years.

What’s the cause? Did anybody tell you?

Sure wasn’t my drinking!

Women of her demographic profile didn’t drink back in the day. /8

Here we are presented with several realities.

A woman and her family are convinced she was healthy as a horse, struck by random affliction, maybe mutilated by the hand of a surgeon. /9

I perceive her random affliction as likely result of eating habits that started years before she got a diagnosis of chronic pancreatitis. Likely suffering some GI symptoms she ignored until she got some pills to mask them. /10

I google for fun to see what explanations people get about chronic pancreatitis (or acute, nothing starts chronically). I find nothing inspiring or pointing in the direction “if you feel sick after eating, consider looking into what you eat”. /11

She’s so sick and her stomach drains so much, nobody knows what to do. Of course common thought was to “have more surgery”.

Of course reasonable course is to leave her be. Give her drugs to alleviate her suffering and hope she can heal within. Time and hope. /12

This archaic approach eventually worked. She got somewhat better.

Her surgeon’s promise was literally 1-3 day in and out experience that dragged into 3 months and permanent debility. /13