A Cautionary Tale

I went for a jog this morning and savored the azure blue sky with sunshine and perfect 55 degree running weather. I also started thinking about a few recent experiences I've had as a new resident and wanted to write them down, perhaps as a caution about some pitfalls of some media outlets and others(mostly males) current thinking about doctors.

The first story is about a 60 year old pleasant gentleman who presented to the emergency room with a complaint of these strange sudden episodes of weakness and blurry vision that had no pattern. It would occur on the left side of the body for approx 5 minutes, both arm and leg, then completely resolve, then would occur suddenly on the right side of the body for a couple of minutes then resolve, then would happen to his right arm and left leg, etc. Sometimes there would be days in between these episodes. Again no pattern. He came to the ED because the episodes were becoming more frequent. I was called to admit him to the hospital and figure out the cause of the episodes. They did not sound completely like seizure activity because he was never confused during the episodes or had a loss of conciousness or bit his tongue or lost control of his bladder or in other others none of the classic seizure signs. It did not sound stroke like because the symptoms would not relapse and remit so quickly. It didn't fit in with any of the other most common causes of sudden weakness either. Truly bizzarre. The only significant piece of history the patient mentioned to me was that he'd last seen a doctor 28 years ago and his feet started going numb 5 years ago. He also was found to have high blood sugar and high blood pressure on admission. So after numerous lab tests and imaging(including MRI's, CT scans etc) that were essentially negative, hours of studying and looking for rare causes of weakness and blurry vision, consulting neurology, and 3-4 days of the patient staying in the hospital, it was finally decided after excluding all the other big bad things, that this man was suffering from complications of untreated diabetes and high blood pressure. He had a few more episodes but they seemed to be slowing down after we started medications to lower his blood pressure and sugar. I discharged him after hospital day #4 with his commitment he would see a family doctor in the next few days and get his BP and sugar under control.

Unfortunately, this story does not end happily. He was brought back to the ER the next day by his son after suffering a more severe episode of weakness that was more prolonged. In the ER, he appeared to go into status epilepticus(a series of sustained seizures) and had to be intubated to protect his airway and sedated to stop the seizures. He was then admitted to the ICU and put on a ventilator. The MRI showed alot of bleeding into his brainstem and other critical structures of his brain that were not there before. He was kept on the ventilator for 10 days when the family decided to remove the life support. He died a few hours later.

Why do I share this story? Because this death was TOTALLY PREVENTABLE, though unfortunately not by me because by the time I saw him it was too late. This man's high blood pressures for over 20 years eventually caused his plumbing inside his body to fail and the blood leaked into his brain. I tried to lower the blood pressure when I saw him, but the damage had already been done. The high sugars also hurt the blood vessels and most certainly caused the numbness in his feet and the blurry vision. He was started on the appropriate medications, and was even started on the proper stroke prevention meds, but it was just too late. Is my point coming clear yet? Why this man didn't go to his doctor when his feet turned numb is beyond me. But intervention at that point, although still late, may have saved his life. I still see his face sometimes at night and feel a small amount of responsibility for his death even though there was NOTHING I could have done differently. The damage was already done.

I have several friends that are approaching the age of 30 who probably haven't seen a doc in years and prob don't intend to for several more. Its just not manly to see a doctor, especially if you are not sick. I plead with you to remember this story and see a doctor, soon. Just for a healthy screening at least. I recently had a physical at the urging of my wife and although nothing was found, had the reassurance I was healthy. Some docs recommend yearly physicals for males, much like the females. I think while in your 30's and money is tight, you should at least have a physical every couple of years, if not yearly. I really don't want to see your face at night, knowing a death could have been prevented if you saw a doctor early and regularly in your adult life.