of her 8 recent admissions
she is 5 years older than me
and until last march, she had a normal life.
then she got sick. her kidneys stopped working.
i mean, stopped working. she got a dialysis catheter placed
and the nephrologist took a kidney biopsy
and sent it to the mayo clinic for evaluation.
it turned out she had autoimmune kidney disease
her immune system was killing her kidneys
so she went on steroids to tone down her immune system.
then she became diabetic because of the steroids.
then she developed a huge retroperitoneal hematoma
from the kidney biopsy. it bled and bled, with the pressure
building up from the blood trapped around her kidney.
she stayed in the hospital for a long time while everybody
tried to decide what to do about this.
as a consequence of lying in bed for a long time
she developed giant blood clots in her deep leg veins
and a piece of clot broke off and went to her lung.
as you know, blocked blood circulation to the lung,
so you can't oxygenate, is a life threatening condition
so despite the bleeding kidney, she had to be put on
blood thinners. this made everybody very nervous, since
she was still bleeding into the limited retroperitoneal space.
eventually she reached an equilibrium between
clotting and bleeding and went home. for two weeks.
then she got a belly ache.
do you know what a diverticulum is? from the latin
for "little detour." it is usually described as an "outpouching"
of bowel lining between the muscular walls. like a bulge
in a weak tire. as folk grow old, they usually get a lot of these.
(of course, this woman doesn't really qualify for 'old.')
sometimes a diverticulum gets jammed up and gets infected
and bursts, kind of like a burst appendix.
this is bad.
you can't just take out a teensy bit of bowel,
due to the way the blood supply is set up. instead
you have to take out the affected bit as well as
all the other bits that are served by that same
blood vessel. the blood vessels are in fan-shaped
arrangements called "arcades." you might recall
from previous writings that i think the intestines are
actually very beautiful, like crinolines or pretty tree fungus.
anyway, she was obliged to have the left half
of her colon removed, trading it for a colostomy bag.
colostomy is from the words for colon and stoma,
"mouth." it's an artificial mouth for the colon.
diabetes gives people problems with wound healing.
so do steroids. so the lady who is five years older than me,
who had a normal life until around st. patrick's day,
started getting all these belly wall abscesses.
these abscesses had to drain, so they were opened
and cleaned and packed and allowed to just drain.
it was hard to tell if they were originating
from a defect in the gut or what. but one thing for sure,
they were infected with antibiotic-resistant superbugs
only found in hospitals. so they could only be treated
with "gorillacillins" - high-tech, hard-core IV antibiotics.
so she went home with a "PICC" line - a semipermanent
IV from her upper arm snaking down almost into her heart -
to get the IV meds without going back to the hospital.
she got a little better - her kidneys got better,
and she could stop dialysis, although she stayed
on steroids to keep her immune system from
whaling away on her kidneys. it had been 3 months
and she was able to stop the blood thinner...
until her legs started hurting and turned red
same way they did when she got the clots before.
and then she began having trouble breathing
whenever she stood up. she started the blood thinner
again, but it didn't help. so last night she came in.
it was a puzzler. she was tested for a blood clot
in her lungs, but she didn't have one of those,
and her blood was quite thin. she was tested
for heart attack and heart failure, and she didn't
have those. not pneumonia, since she didn't
have any fever, she sounded clear, and her
x-ray was normal. the PICC looked properly placed.
we wondered if she had a bad infection
from the still-draining abscess, the colostomy wound,
the PICC line, or the apparent soft-tissue infection
of the legs, since she did have an elevated white cell
count... then she went into "A-flutter." atrial flutter.
this means the atrium of her heart was just
twitching instead of pumping. she said she felt fine -
just pain in the belly and legs, and not breathing rght,
same as before. i wasn't sure what to do -
leave it alone? she felt okay, and her pulse
and blood pressure were doing fine without her atrium...
could it get worse? should i nip it in the bud?
should i give this woman - with the semipermanent
PICC and on the IV gorillacillin for her
nonhealing belly abscess, anticoagulated and
diabetic, on steroids with an autoimmune process,
with the red legs, in pain, struggling to get air -
something to change the very way her heart beats?
and why did she come back in on my shift?
glumly i remembered all the mean phrases
we're not supposed to use, like "trying to die,"
"voting herself off the island," "DMA" (dying
with medical assistance), "transferring to the 10th floor"
(if you have 9 floors), and "prepared for celestial discharge,"
and how the NICU nurses would warn the sick babies,
"step away from the Light"...
anyway, i gave her one dose of flecainide, just before
the cardiologist called back and told me there was no
indication for flecainide, and he'd scan her in the morning.
i'd already given her some morphine. so when i headed
back in for the last time to check on her, she smiled at me
very sweetly and said, "i feel so much better now..."
and then, still smiling, two fat tears rolled down her cheeks.
iatrogenic: induced by a physician's words or therapy
iatrogenesis is a little script that spews out random stuff to a bunch of people every day
iatrogenesis is a country that is ruled by those who do not love her
iatrogenesis is 10 years according to the arranged horoscope table
iatrogenesis is the more silent as it penetrates deeper
iatrogenesis is an automatic claim on everyone else's life
iatrogenesis is unevenly weighted
iatrogenic keratoconus causes the cornea to bulge
posterior screws were used despite the risk of iatrogenic injury to the vertebral artery
iatrogenic injury to the saphenous nerve and vein, as well as to the popliteal vessels
iatrogenesis is connected neither to any good or bad deeds
iatrogenesis is often due to no specific cause; it is simply the bad fortune of an individual; a link in the chain of events; an evil independent of his own
iatrogenesis is really a lesson to be learned
iatrogenic events can be a source of intoxications in our community
a few of the overdoses resulted from physician-initiated inadvertent addiction (iatrogenic addiction)
36% of 815 consecutive patients on a general medical service of a university hospital had an iatrogenic illness
iatrogenesis is a good story the beginning of a good film
iatrogenesis is what you chose for your evening meal
iatrogenesis is entertaining
iatrogenesis is one of darkness' other goblin minions
iatrogenesis is the tip of the iceberg
emergency delivery may result in severe iatrogenic prematurity
ominous iatrogenic events are frequent in neonatal units
nurses' fingers were contaminated with bacteria known to cause iatrogenic infections
iatrogenic blood loss due to lab testing can result in the need for blood transfusion
iatrogenesis is applied failure
iatrogenesis is not determinable by an outsider's measurement of it
iatrogenesis is due to a defective apprehension which the wider view confirms
iatrogenesis is called "first" because there's always a second one
fatal iatrogenic hypoglycemia: falsely elevated glucose meter readings due to a maltose-containing intravenous immune globulin
iatrogenic injury to the lateral antebrachial cutaneous nerve and superficial branch of the radial nerve
iatrogenic CJD or kuru acquired through the use of cadaver-derived growth hormone
iatrogenesis is worse if one "gets the hook" unexpectedly
iatrogenesis is not just a misfortune
iatrogenesis is our own creation
a 21 year-old woman presented with unrecognized renal tuberculosis and underwent bilateral ureteral stent placement which led to dissemination of the mycobacteria through the blood causing pulmonary tuberculosis and multiple tuberculous abscesses in the paraspinous muscles, pleural space and skin.
iatrogenesis is now available at the bodacious blunder section to your right
iatrogenesis is stuck at ten reads and three reviews with a status of good
