You DON'T want to be the interesting patient....

I was in the ICU this past week and I discovered one main theme. You never want to be the Doctor's 'interesting patient'. Trust me it just = bad news. And in the case of my patient it proved to be true.

My patient -- 72, f, Diagnosis: Atrial fibrillation.

History: She came through the ER over a week ago due to general malaise "I just don't feel well". She has a big history of COPD (chronic obstructive pulmonary disease) and is on 2 liters of oxygen at home (former smoker). Her quick diagnosis in the ER was Atrial fibrillation. She was in the ER for about a week having breathing problems in addition to the heart dysrhythmia. She had an NG (nasogastic) tube for feedings. Thursday AM in Telemetry she has an exacerbation of SOB (shortness of breath) while they tried to get her to sit on the side of the bed. Her O2 SAT's (saturation) goes down below 75 and they have respiratory therapy come and get her on a bipap machine to sustain the needed O2 level of over 90. So, she comes back to the ICU. Now she is being assisted by the bipap machine (it's not a ventilator, it forces the air in via a mask without a tube).

Her in-house Doc orders a pulmonary consultation for that night which they do a bronchoscopy and can't "see much" due to some possible clots. They have to put her on a ventilator to sustain her breathing. So, they reschedule for Friday AM to repeat the procedure.

They do this procedure in the room and I got to be there. Essentially they put a tube with a camera attached down the mainstem bronchial tube to look in her lungs. Well, what they find is a fistula in the mainstem bronch that the NG tube can be seen laying in. Keep in mind the NG tube is in the esophagus and the bronchoscopy tube is in the lungs (past the epiglottis the two never shall meet). It seems the wall of her brochial tube has eroded due to a massive amount of cancer and the erosion goes into the esophagus. The Doc removes the NG tube at which point he moves the camera into the hole and looks into the esophagus! He also backs the camera up and shows the massive cancer spreading over her mainstem bronchial tube. He takes a few biopsy samples, photos from the camera and exits.

And then repeats the infamous words, "in 20 years of doing this type of procedure I have never seen this."

During the procedure many nurses from ICU and Tele are filing in for a look and I feel like I hit the student jackpot.

Unfortunately, for the patient, Doc says they can not remove her other lung because of the end stage COPD she couldn't function on one already compromised lung. This is a terminal diagnosis of lung cancer and this patient will never get off the vent besides the fact she can not eat unless a tube is placed into her stomach. Prognosis is to remove the vent and see how long until she passes.

I also got to experience her Doc tell her daughter the prognosis. It was hard to keep my composure. Friday was an interesting day.