bummer

[nephron]

After training in Kali, 2 years ago I moved home to SWK to take care of my people & the area I grew up loving. About 8 months ago, I started a pheresis program specifically for one 38 year old male with homozygous Type II Dyslipidemia (cholesterol about 1200, LDL about 650)--this procedure involves using a continuous centrifugal plasma/blood separator, removes his cholesterol, returns his blood cells & "fresh" 5% albumin.

He had had a 4 vessel coronary bipass procedure at 32 years of age, but we had his LDL down to 120-150 & things were looking up. Since I was apheresing him once/week, I got to know him well, including all of his personal/family problems.

Well, for some reason, he skipped his treatments over the last month, started smoking, & died a couple days ago, suddenly. Most likely cardiac arrest. :ugg:

38 years old. I'm having a real hard time with this one. Sure, I take care of a lot of youngsters on dialysis, & see them frequently as well, but this one really bothered me. I'm not sure why I'm saying anything here, but just wanted some here to know what I go through. It's not easy. And despite what many think of docs, we do care. For me, when someone like this dies, it's almost like losing a family member. Certainly, like losing a friend.

I'm going to his funeral today.:(

 

[VintageDirt]

I'm always at a loss for words in these situations. So I usually avoid these topics. Doesn't mean I don't care, it just means I don't know what to say.

Don't let it get you down, the work you do is important. Like you said, you were his friend, so you know he had at least one good friend.

Take care.

 

[XRpredator]

Look at it this way, Doc. Because you care so much about your patients, you are a good doctor. It's gotta be hard, but you're only human.

You are one of the good guys. :)

 

[zio]

Yeah, what VintageDirt said. At least you opened up & let it out. Talk is theraputic, you know that. Glad you shared it with us. We're real people behind the stupid screen names, & when it comes down to these big things we care. :)

 

[txvintage]

Nephron, you can be my family's Doc anytime. Seems like too many look at you as the next guy in the check out line.

 

[Senior KX Rider]

Originally posted by nephron


Well, for some reason, he skipped his treatments over the last month, started smoking, & died a couple days ago, suddenly. Most likely cardiac arrest. :ugg:

.:(

Sorry to hear that but you can only do so much to save a person. They have to be fighting as hard as you are.

 

[nephron]

Thanks guys.

Didn't want to sound like a whiner, or win any hearts. That wasn't the goal. Just wanted to share, so thanks for the replies. Of course, I've got plenty of people to unload on, including my family. And I do.

He was an ornery fart. :) Quite a good little fella. Great personality. Everyone here is pretty bummed.

 

[BSWIFT]

It is not easy to stay removed from everything in your profession. Life is presious and death causes a deep sadness. The DRN family is just that, a family. You share the same love of motorcycles as do the rest of us. I send you my deepest condolences and hope that you overcome your sadness in due time.

 

[Okiewan]

hard subject to respond to.
I guess in your profession, you have to make the most of the lives you enhance. Death is a really bad deal. I feel for ya bro.

 

[BunduBasher]

tough one nephron, you did your best, and none of us live forever, no matter how hard we try.

Any reason as to why he quit his treatment ? Man 38, I turn 36 this year :ugg:

 

[nephron]

He was getting frequent upper respiratory tract infections. Plasmapheresis involves removing the plasma & replacing it with 5% albumin. Well, your antibodies live in the plasma, so with removal of it, you become immunosuppressed.

Because of that, I was in the process of setting up a filtration separator followed by LDL-exchange columns (columns covered in LDL receptors)--when the separated plasma runs across these filters, only the LDL is removed via the LDL receptors bound to the membrane latching onto the LDL in the plasma. The rest of the plasma is returned to the patient intact--including the antibodies.

He was taking a "self-advised" break, which I couldn't argue with in light of the low immediate/interval risk. The only thing that might have changed acutely (besides LDL level) would have been endothelial function. However, I have the feeling he hastened the process by smoking, which is the most endothelial toxic substance you can put into your vascular system. ie, the endothelium weakens, becomes spastic, & becomes predisposed to plaque rupture and thrombus formation--total vessel occlusion.

Who knows, maybe it would have happened anyway. :(

 

[marcusgunby]

Nephron i know where you are coming from on this-most people would find it hard to grasp what its like working with people that are living on borrowed time-its hard to come to terms with death and most people(hopefully) only have to deal with it rearly.
On a lighter note, i understand only part of what you are talking about on the medical side so the rest must think you are talking in greek:confused: