A triumph for our trainees but a tragedy for the patient

The patient gave permission for all photos to be taken and published here

It is difficult sometimes in medicine to temper the interest and maybe even excitement over seeing something abnormal, and reminding ourselves that there is a patient attached to that rare or interesting finding. In teaching at the bedside it is important to remind our trainees that we must respect the true teacher in the room--the patient. Today’s focus is a patient who I am so sad about. He is a 21 year old male who came to Ayder with shortness of breath, he was found to have a significant amount of fluid around his heart and luckily when he came the CT scanner was working so he was able to obtain a scan which showed a large mass sitting inside of his chest. The location of this mass was worrisome for several things including lymphoma. He was evaluated for several different types of infections, fungal and TB especially. Tuberculosis (TB) can really present as anything. After all that was completed he was started on steroids under the presumed diagnosis of Lymphoma. Biopsies were taken, the fluid was drained, he remains on a ventilator because the mass is so big that it is compressing his trachea. Given that he has no indication for sedation, he is getting only intermittent doses of thiopental as needed(a medication we really do not use in the US but is cheap and available here)—this is such a stark contrast to our patients back home who generally end up requiring some level of sedation even continuous infusions to keep them calm and comfortable on the ventilator—I imagine its because we have a lower threshold to start these medications and of course they are more readily available. Back to the patient—he was biopsied and we await the results however given the concern for progression it was decided that he empirically be started on chemotherapy. We shall see how he does—I hope for the best for him, he has his entire life ahead of him, he is awake and interactive and even jokes around with us. Human beings and their capacity for resilience is truly something to behold. The depths of pain people can go through and still remain positive is awe-inspiring to me.