Through difficult times
I write stories of my patients, mostly about the difficulty of diagnosis in medicine, treating them and of course the myriad of emotions I undergo while I treat them.
This story is rather special, when the patient is your best half. The emotions are definitely a myriad. The conflict of being a doctor and a wife is not an easy one.
My daughter and me were eagerly awaiting his arrival from America, it's been five full days since we last saw him, everyone said, it's such a short trip to fly to US and get back. I did feel five days were a lifetime. I am unapologetically romantic! There he was, bag full of goodies for the little one and of course for me. He insisted I will beat the jet lag, no sleeping let's do our favourite activity trek to the forest.
The following day, he developed high grade fever with severe body ache, generalised weakness. Looked like a viral illness, treated with good hydration, antipyretics and rest. Seemed to improve a bit over next 2 days. Fever came back with severe intensity and apart from mild ear ache, there was no source of infection was found on clinical examination. Fever persisting for 5 days, got me worried especially with no other clinical signs, it warranted a round of blood tests, urine tests, chest x-ray. All the investigations came back normal further supporting a probable viral cause.
It's easier to treat a heart attack or a stroke, most physicians will agree, it's most difficult to treat a fever of unknown origin. Fever is only a symptom, its actually body's response to infection and sometimes inflammation, there are hundreds of causes. It's definitely a clinical dilemma how much and what to investigate and a bigger dilemma is whether treat with empirical antibiotics, he had mild ear ache, no ear discharge but I decided to start empirical antibiotics. He was admitted for few hours, gave him intravenous saline infusion and he felt significantly better. The fever was getting better, again a difficult assessment whether fever was better with antibiotics or the viral taking its own course.
On the 7th day of illness, there was no fever but he developed a headache of moderate severity and was responding to analgesics and rest. He drove to work next day to finish some important work and said he managed. I thought it was typically the end of a bad viral infection.
The following day, he woke up with severe headache, looking pale, dehydrated. It got me completely worried. I said we need to go the emergency right now, I am not sure what's happening, he said we will wait, its just a headache it will get better if I sleep. May be I was worrying too much, as a doctor, you just know too much and I decided to wait for couple of hours. In next 1 hour, headache was worsening and I could sense his response was delayed, looking blank and probably disoriented. That's it, my heart started pounding, it could be encephalitis, cortical venous thrombosis or any other intra cranial event or could be more common hyponatremia. I had so many conditions running in my head. I summoned the ambulance, called the emergency department Head, picked up my 4 year old daughter and dropped her in friend's place and next thing I know, we were in ambulance in 15 minutes. My fears worsened when he grew restless and started vomiting in the ambulance. It was the longest 20 minutes of my life.
At the emergency, he started getting restless and completely disoriented, cortical venous thrombosis was strongly suspected and immediately MRI Brain and MRVenogram was planned. Few of my most trusted friends arrived with just a message. Blessed to have them!!
Thankfully, the imaging turned out to be normal.He was shifted to the neuro ICU where he was kept under observation for few hours and lumbar puncture was done and cerebrospinal fluid was removed and sent for testing.
At my insistence as a doctor, I got him shifted to the ward. CSF Studies revealed a picture of viral meningitis vs partially treated bacterial meningitis. The earlier course of antibiotic can vary the result of CSF making it difficult to say if its purely viral meningitis.
Meningitis is inflammation of meninges, the membrane surrounding the brain and spinal cord. Causes can be viral, bacterial and fungal infections. While, viral is the most common and self limiting, bacterial meningitis is severe and warrants immediate treatment.
That explained his severe splitting headaches and extreme restlessness. It might sound dramatic now, but what followed was three days and three nights of no sleep, severe unrelenting headaches. It is distressing to see your most loved one in that condition and at that same time utter helplessness as a doctor. I also learnt a very important lesson through this few days that how resilient we are, I managed well with few minutes of power naps and how I
remained calm and positive.
Well, we all are much more resilient then we can ever imagine!
Next, 1-2 weeks went on in gradual recovery, discharged home and continued care at home.
Well, as a doctor, I want to find out what could be possible virus for this meningitis, a friend pointed out west nile outbreak in this season in US, looked up all the reports. The week he travelled to US and that particular place, there was an outbreak of west nile encephalitis. While, treatment doesn't change prognosis could vary. Thankfully it was meningitis and not encephalitis so prognosis is good.
Thanks to the family and friends who heartfully helped us. We sailed through this tough time with all their help and prayers.
I can't say how understanding and supportive my 4 year old daughter was, she handled the entire situation so beautifully, she kept me going. I am a proud mommy!
I have learnt a lot from this experience. Medical emergencies can happen to anyone and at anytime, it's good to have some kind of plan in place. It's good to talk about these things. Thanks to my best half a thorough organised techie, I had everything at my finger tips. All necessary documents like insurance card, id card, etc all accessible through a drop box on my phone. He had literally coached me, much to my resistance to take care of finances, net banking over last few years. I definitely felt lot confident that I could handle the situation. In my experience as a doctor, I have seen women not being able to take key decisions, they mostly rely on their partner. That needs to change, emergencies are a different thing all together.
Only thing I wanted through all these weeks was, a tiny bit of normalcy! The most underrated pleasure is to have, just a normal day!
Blessed and happy to have just a normal day today!!!
This story is rather special, when the patient is your best half. The emotions are definitely a myriad. The conflict of being a doctor and a wife is not an easy one.
My daughter and me were eagerly awaiting his arrival from America, it's been five full days since we last saw him, everyone said, it's such a short trip to fly to US and get back. I did feel five days were a lifetime. I am unapologetically romantic! There he was, bag full of goodies for the little one and of course for me. He insisted I will beat the jet lag, no sleeping let's do our favourite activity trek to the forest.
The following day, he developed high grade fever with severe body ache, generalised weakness. Looked like a viral illness, treated with good hydration, antipyretics and rest. Seemed to improve a bit over next 2 days. Fever came back with severe intensity and apart from mild ear ache, there was no source of infection was found on clinical examination. Fever persisting for 5 days, got me worried especially with no other clinical signs, it warranted a round of blood tests, urine tests, chest x-ray. All the investigations came back normal further supporting a probable viral cause.
It's easier to treat a heart attack or a stroke, most physicians will agree, it's most difficult to treat a fever of unknown origin. Fever is only a symptom, its actually body's response to infection and sometimes inflammation, there are hundreds of causes. It's definitely a clinical dilemma how much and what to investigate and a bigger dilemma is whether treat with empirical antibiotics, he had mild ear ache, no ear discharge but I decided to start empirical antibiotics. He was admitted for few hours, gave him intravenous saline infusion and he felt significantly better. The fever was getting better, again a difficult assessment whether fever was better with antibiotics or the viral taking its own course.
On the 7th day of illness, there was no fever but he developed a headache of moderate severity and was responding to analgesics and rest. He drove to work next day to finish some important work and said he managed. I thought it was typically the end of a bad viral infection.
The following day, he woke up with severe headache, looking pale, dehydrated. It got me completely worried. I said we need to go the emergency right now, I am not sure what's happening, he said we will wait, its just a headache it will get better if I sleep. May be I was worrying too much, as a doctor, you just know too much and I decided to wait for couple of hours. In next 1 hour, headache was worsening and I could sense his response was delayed, looking blank and probably disoriented. That's it, my heart started pounding, it could be encephalitis, cortical venous thrombosis or any other intra cranial event or could be more common hyponatremia. I had so many conditions running in my head. I summoned the ambulance, called the emergency department Head, picked up my 4 year old daughter and dropped her in friend's place and next thing I know, we were in ambulance in 15 minutes. My fears worsened when he grew restless and started vomiting in the ambulance. It was the longest 20 minutes of my life.
At the emergency, he started getting restless and completely disoriented, cortical venous thrombosis was strongly suspected and immediately MRI Brain and MRVenogram was planned. Few of my most trusted friends arrived with just a message. Blessed to have them!!
Thankfully, the imaging turned out to be normal.He was shifted to the neuro ICU where he was kept under observation for few hours and lumbar puncture was done and cerebrospinal fluid was removed and sent for testing.
At my insistence as a doctor, I got him shifted to the ward. CSF Studies revealed a picture of viral meningitis vs partially treated bacterial meningitis. The earlier course of antibiotic can vary the result of CSF making it difficult to say if its purely viral meningitis.
Meningitis is inflammation of meninges, the membrane surrounding the brain and spinal cord. Causes can be viral, bacterial and fungal infections. While, viral is the most common and self limiting, bacterial meningitis is severe and warrants immediate treatment.
That explained his severe splitting headaches and extreme restlessness. It might sound dramatic now, but what followed was three days and three nights of no sleep, severe unrelenting headaches. It is distressing to see your most loved one in that condition and at that same time utter helplessness as a doctor. I also learnt a very important lesson through this few days that how resilient we are, I managed well with few minutes of power naps and how I
remained calm and positive.
Well, we all are much more resilient then we can ever imagine!
Next, 1-2 weeks went on in gradual recovery, discharged home and continued care at home.
Well, as a doctor, I want to find out what could be possible virus for this meningitis, a friend pointed out west nile outbreak in this season in US, looked up all the reports. The week he travelled to US and that particular place, there was an outbreak of west nile encephalitis. While, treatment doesn't change prognosis could vary. Thankfully it was meningitis and not encephalitis so prognosis is good.
Thanks to the family and friends who heartfully helped us. We sailed through this tough time with all their help and prayers.
I can't say how understanding and supportive my 4 year old daughter was, she handled the entire situation so beautifully, she kept me going. I am a proud mommy!
I have learnt a lot from this experience. Medical emergencies can happen to anyone and at anytime, it's good to have some kind of plan in place. It's good to talk about these things. Thanks to my best half a thorough organised techie, I had everything at my finger tips. All necessary documents like insurance card, id card, etc all accessible through a drop box on my phone. He had literally coached me, much to my resistance to take care of finances, net banking over last few years. I definitely felt lot confident that I could handle the situation. In my experience as a doctor, I have seen women not being able to take key decisions, they mostly rely on their partner. That needs to change, emergencies are a different thing all together.
Only thing I wanted through all these weeks was, a tiny bit of normalcy! The most underrated pleasure is to have, just a normal day!
Blessed and happy to have just a normal day today!!!