Rare

Don't ignore the rare. They teach.

Rare

As a family doctor you go through years of classes and training and learn a lot of shit you never see. But maybe it’s in there. Some you hope to never see. But hoping is stupid. So the Buddha says.

Sid learned about the viral hemorrhagic fevers. Marburg, Ebola, they made the news. Maybe he even heard about Hanta. But when he was watching this woman die, it’s one of the first things his weak mind thought of. Funny that, the learning thing, the memory. Us humans are so poor at remembering. Maybe AI would be better. We don’t remember the last politician who screwed us, but we kind of recognize his name, so we vote for him again.

Maybe that sort of weak memory is what Sid had, just a name, some symptoms. But when he watched her die, he really remembered.

Sid got a call from the PA working down at the urgent care clinic. She had recognized the severity of this woman’s illness and sent her to the ER. And she had called Sid. She’s really sick. I think you should go in and see her.

So Sid got on his professional clothes. He had been out trying to get the lawnmower to start and run decent. His shirt was dirty and his hands smelled of gasoline. He changed his clothes and headed in.

She wasn’t in the ER; she had already been moved up to the little hospitals ICU. So that’s where he went.

But he read what they had. Blood in her urine. Platelets low. Chest x-ray shows acute respiratory distress syndrome, lungs filling with fluid. Oxygen levels very low. Sid called the lab and asked if they could send the serum off for Hanta. Sure, it will take a couple days. Then he went upstairs.

Sid recognized her. She had yelled at his daughter on the T Ball field. Come on, make the throw!

But here she was breathing 50 breaths a minute, barely able to say a word. And her oxygen saturation in her blood, even with all her effort, was dismal. Sid knew where this was heading. He told the nurse to get ready for intubation.

Sid knew he could give oxygen. We can give you 100% oxygen in a mask over your nose and mouth. The air you breathe only has 20% oxygen. But if this isn’t enough, we can force oxygen into your lungs through a tube. It goes past your vocal cords, and a cuff is inflated down there so we can use pressure. But you hate this, you fight and gag, so we sedate and paralyze you, so you won’t fight us as we try to save your life. Sid had done this too many times. The gunshot, the motor vehicle accident, the pneumonia; all these folks needed oxygen. Or they would die. Some lived.

But this patient he knew from the ball fields was bleeding into her lungs. No pressure they applied would combat the melting of her small vessels that she relied on. The virus melts little vessels. Hemorrhagic viruses do this.

They are special. They melt our bodies essential tiny connections. But, because of biology, they do not transmit easily. A virus that kills it’s host quickly does not propagate through aerosol. A virus that kills quickly needs another path than a cough or sneeze. If so, we would all be dead and then so would they. A virulent virus doesn’t want a lot of people dead.

Our mistake is that we are thinking of this from our perspective. We are so afraid of really bad things. And we should be. Lions and tigers and bears. But it’s the slowly lethal virus or bacteria that kills the most of us. Fast is fatal. Slow can be too. And slow allows for more spread. It’s just what we all do. Strategies, functions, kill quickly or slowly, what is the end game? What is winning?

But this is all theoretical bullshit. Though it wafted through Sid’s mind as he watched this woman die.

And he had to decide when to do the forceful intervention. Once the tube is past the vocal cords, the cuff inflated and the patient sedated and paralyzed, the conversation is over.

Sid leaned into this vocal mom he knew from the ball fields. She was sitting up, breathing fast for her life. Breathing so fast she could only get one word out between breaths.

Sid told her about the intubation, the paralysis, the sedation.

She stared at him as he went through all the details.

Sid quit his litany and just looked at her as she worked to breathe. Her arms were on the rails, holding herself up with the little strength she had left. Her eyes bored into him.

Doc…am…I…going…to…die…?

Sid knew his eyes told her. But he tried to say the right words. They got her intubated and onto the helicopter, but she died before she landed on the top of the 14-floor big city medical center.

The test came back positive on the weekend. Sid saw it. Four days later the new hospital CEO called him to let him know there had been a death from Hanta virus in the hospital. Sid thanked him for the call and thought him an idiot. And Sid knew the asshole made more than twice what he did. And he didn’t take call or care for dying patients.

Sid was out in the garage again, sorting screws or cleaning up when he was crippled by the absurdity. It hit him in these moments. Maybe it was the Pearl Jam on the stereo, I wish I was the full moon shining off a Camaros hood.

Knowing and appreciating absurdity teaches us to listen.

Sid was covering the ER for extra money on the weekend. He knew the lady. He liked her, but she was here because, “I just don’t feel good.”

They can never tell you the problem. It’s his job to figure it out.

So he did the exam, ordered the tests. Her liver enzymes were out of whack.

So Sid asked some more questions. Tylenol, solvents, alcohol?

Doc, I been cleaning out a shed behind my house. I want you to test me for that Hanta virus.

Hanta?

Yeah. Lots of mouse turds out there.

Sid probably rolled his eyes. Look, if you had Hanta you’d be dead by now. And it’s going to take a couple days to get the result. But you are sick enough I think you ought to spend the night in the hospital. I’ll order the test, but I think it’s something else.

The next morning her liver enzymes were better and she felt pretty good. And the lab had improved it’s Hanta immunoglobulin turn around. She was positive for acute infection.

So Sid told her, thanked her. She went home well, to die later of something else.

And Sid learned.