Chapter 1 continued…pondering a difficult diagnosis

The lab results came back to doc’s emr in box the next day. The CBC told the story. WBC’s low with a predominance of immature lymphoid cells, a hemoglobin of 9.2 and platelets of 14,000; pancytopenia with anemia significant enough to be a major component of Pat’s fatigue. As they reviewed these results by telephone and after hearing the doctor’s monologue punctuated with the terms “hematology eval, bone marrow biopsy and we will see you back after the hematology consult to review recommendations” Pat was in a state of disbelief. He was a medical minimalist, usually seeing his doctor once every 2 to 3 years. Accustomed to being healthy and active, his lifestyle fostered a strong sense of individualism and self sufficiency. In addition to his running, he enjoyed camping and biking. He sat down at his computer to search out information on leukemia and lymphoma and to form a plan of attack…

Doc’s office called the next day to touch base. They had talked with the hematology group at the local university and scheduled an initial appointment for him. He would be seeing doctor X next week. In the meantime He was ok’ed to continue all his usual activities of daily living but to hold off on his running for now. Meets doctor, dx established induction chemo given.

One week after his initial round of chemotherapy he developed a fever. 2 days prior to the fever he had started with a dry cough. This night he was pacing as he could not sleep and was feeling increasingly short of breath. This prompted a call to his doctor’s office and he described his symptoms to the on call physician. He was instructed to go to the emergency room for further evaluation. Upon arrival and after triage he was placed in a room and promptly gave and reiterated his medical history and the current course of events to the ward clerk collecting his insurance information, the nurse and finally the ER doctor. He continued to feel dyspneic and uncomfortable and his most recent vitals showed his bp was low, pulse fast, temp high and oxygen sat low. His chest xray returned showing a left lower lobe infiltrate and the cbc a profound anemia and neutropenia. “We will need to put you in the ICU for treatment pf pneumonia and sepsis and give you a blood transfusion to help with the anemia and oxygenation”. “This sort of problem can happen when the chemo knocks down the good cells to get at the bad cells so we will need to support you through it”. The ER doctor informed him that both his primary physician and hematologist were out of town so the hospitalist would do the admission and gather the consultants to continue care. A sense of vulnerability began to set in. Pat thought, “no family to call, I do not know any of these doctors or nurses, they are putting me in the ICU and I feel like I cant breath”.


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