On Thursday morning, Dr. Tseng grimly greeted Jessica and I and said, “I was just told that the patient has expired.” It took me a second to realize what he meant by “expired.” Once the truth clicked, my mind screamed quietly, “No! This can’t be happening!” Despite what we learned in class about breaking bad news (the ABCDEs) I was not mentally prepared for a such heavy task in the morning. My eyes focused on Dr. Tseng as the patient’s son walked into the room to see his mother one last time. Dr. Tseng told the son the official time of his mother’s death while maintaining his composure. The son lightly stroked his mother’s forehead before he walked away with tears in his eyes. I was touched by the son’s simple yet genuine act of love. Dr. Tseng gave the son quiet time for mourning - he showed a great example of what it means to be a physician in times of need, but a bystander in moments of silence. I realized a physician must be ready to deliver bad news at anytime of the day. I hope I will have the resilience to handle these tough situations with compassion, as Dr. Tseng did.
We spent the rest of Thursday morning running around ICU and wards. We saw a patient with septicemia, infected by Aeromonas hydrophila (a very rare opportunistic pathogen). Then, a patient was newly admitted to the wards under the working diagnosis of pneumonia. After Dr. Tseng asked her a few questions for H&P, examined her tender leg, he diagnosed her with cellulites. I was impressed with Dr. Tseng’s quick thinking.
There was a patient’s family who wanted to discuss with Dr. Tseng about the options presented for the patient. They were deciding between prolonged intubation versus tracheotomy. Dr. Tseng talked about the advantages/disadvantages for each. Risks for intubation include higher chance of infection, lack of dental hygiene, dependency of ventilator, chance of extubation failure. Risks for tracheotomy include surgical risks, as well as the fact that the patient is an elderly who might not respond well to surgical intervention. Dr. Tseng acted as a consultant to the patient’s family, giving them the power to decide on best treatment for the patient. I was inspired by the workings of personalized medicine. Dr. Lin had a family emergency in the afternoon, so we were unable to shadow him. We wished him well and began to prepare for the next day’s rotation.
We followed Dr. Chien in OPD on Friday morning. We saw some interesting cases. A patient with coal miner’s pneumoconiosis, more specifically, progressive massive fibrosis. Patients with this serious type of pneumoconiosis typically present COPD symptoms. I noticed some drugs Dr. Chien frequently prescribes. One is Spiriva (long acting anticholinergic bronchodilator) for COPD, and Symbicort (budesonide/formeterol) for COPD and asthma.
A patient came in with scoliosis skewed to the right had an underdeveloped right lung. Her SpO2 =67% (>88% is ideal). Although she had a home oxygen therapy, she did not have a pulse oximeter to measure her oxygen saturation due to financial difficulties. This was the not the first time financial difficulty has been mentioned. I previously mentioned a patient with OHCA in vegetative state. Her mother came to talk to Dr. Chien about palliative care for her daughter. Due to her financial crisis, she had been unable to find a place that would take her daughter for a lesser charge. Dr. Chien reassured her that many hospitals have funds for these situations and referred her to the social work department. It was great to see how Dr. Chien supported his patients both medically and financially. I was also inspired by how well Taiwan’s healthcare is set up to accommodate those in financial need.
Before I conclude my respiratory rotation, I want to share with you this book that Dr. Tseng highly recommended: Sanford Guide to Antimicrobial Pocket Medicine. It has been another amazing week!
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