The
Consult
It
was spring and I had just returned home from a long day at work, when
the phone rang. It was my mother calling from Florida. My father had
taken ill suddenly and had to be rushed to the hospital. He was in
his eighty's and had been in poor health for a while. He had heart
disease and Diabetes and had been undergoing treatment for diabetic
foot ulcers.
I
called my sister who lived close to them. She was in the hospital
with him. She said it did not look good. Both his heart and kidneys
were failing and he was being admitted to the intensive care unit. I
immediately arranged for a flight to Florida the next day. My brother
and other sister were also rushing there.
The
next day all four siblings met at my father's bedside in the
hospital. It had been several months since all the siblings had been
together. The doctors told us that he had suffered another heart
attack, and this time he had badly damaged his heart. His heart was
failing and his kidneys were failing too. He continued to decline and
having difficulty breathing. After three days in the intensive care
unit, we as a family decided to make him primarily comfortable.
He
was placed on morphine and moved to a regular room. He looked much
more comfortable and we all took turns staying at his bedside. He was
then moved to a hospice center. I was sitting next to my father in a
darkened room. He looked quite comfortable, and I was reflecting back
on his life, when suddenly I received a text message on my work
phone. It was from one of our resident doctors back in North Carolina.
He
had an interesting patient. It was a visitor from Africa, who had
come down with Malaria. I was the only Infectious Disease physician
in my hospital and thus the request for advice. I texted back my
suggestions for treatment. Doing this actually helped me deal better
with my father's illness. Early next morning my father passed away peacefully in
his sleep. I and one of my sisters were at his bedside.
After
this, we got busy with funeral arrangements and taking care of my
mother. My colleagues at the hospital were very kind and send many
condolences. One of the residents at the hospital even got a
collection of money from the other residents and made a donation in
my father's name to the Diabetes foundation. They also arranged for a
tree to be planted in his name at a state forest. I was very touched
by these gestures.
The
day after the funeral, I thought about the Malaria patient again. I
had the ability to do a 'teleconsult' using my phone and a tablet
computer at the hospital via a secure connection. Medical residents
and my physician assistant would examine the patient, then connect me
online, so I could directly communicate with the patient.
I
did do the consultation and speak to my patient. While he was from
Africa, he was of Indian descent. He reminded me of my father, who
spend decades in Africa but was also of Indian descent. In a strange
way, taking care of him helped me deal with my Father's death. The
patient was doing better and the malaria parasite had been cleared
from his blood.
Our
patient told me that he had come to our small town in North Carolina
because apparently this was a manufacturing center of agricultural equipment for the type of large cotton farm he ran in
Africa. He was subsequently discharged and went back to his hotel
room in town.
A
few days later, I was back at work. In the hospital we were consulted
again on our Malaria patient. Back in his hotel he had developed
abdominal pain with persistent nausea and vomiting and been readmitted. The scan of his
abdomen showed a significantly enlarged gall bladder.
At
our consultation, we determined that his gall bladder enlargement was
a complication of his malaria. The malaria had been cleared, but he
had developed this condition called “acalculous cholecystitis”.
This is a very rare complication of malaria.
We
asked our surgeon to remove the gall bladder, which he did. After the
surgery, our surgeon told us that the gall bladder had been removed
just in the nick of time as it was close to rupture. Our patient made
a complete recovery and eventually went back to Africa.
This
was a very rewarding experience for me. Watching this patient's
complete recovery helped me heal from losing my father.
I
hope this patient continues to do well and is successfully running his
farm today.
Anopheles mosquito carrier of Malaria
