Heart failure

In creating good health, we should be open to other modalities of care, which include complementary medical practice - especially where an economic advantage can be proved.  Sometimes, though the 'patient agenda' can simply boil down to five minutes of listening.

Without it, a patient's motives may not be all too easily obvious, as indeed occurred in Mary’s case.

To everyone’s surprise, and even aggravation, this 75year old chose to discharge herself from hospital against all medical advice. She returned to me a few days after I had arranged emergency hospital admission for her with suspected heart failure and/or pulmonary emboli.

When Mary first saw me after discharge from hospital her symptoms had not changed much. She knew little of her diagnoses but showed me the antibiotics she was complying with.

As is unfortunately not infrequently the case these days (despite all the IT), I as her GP had little more information at hand and was alarmed that she had gone without anticoagulant treatment commenced in hospital while pulmonary emboli still remained a possibility.

A telephone consultation with the hospital consultant revealed their struggle to keep Mary in for a pulmonary scan. It did not help matters that one of the scanners had broken down, and Mary’s notes had been confused with another patient’s for a brief episode on the ward round.

Mary’s family had not taken kindly to this – feeling insecurity in the care provided. The consultant said he even explained to Mary that she risked death if she discharged herself with incomplete investigations, and anticoagulant treatment prematurely discontinued. 

My chat with Mary revealed that she could grasp the mistake over her records, and understand the broken scanner, but she had been unable to reveal the real determinant of her self-discharge to ‘anyone’ of the many ‘shifting’ and very busy doctors/nurses on the ward.

I had to prize it out gradually knowing this lady of integrity and strength for many years in my practice. Mary reported that due to lack of beds her first night was spent in the emergency admission ward with a constant stream of patients and practitioners’ coming and going.

The next two nights even though on a normal ward, unfortunately there was a 90 year old confused ‘sweetie’ who kept climbing into Mary’s bed!

Without much sleep, by the 4th day even though her breathlessness was not worsening Mary recognized a feeling that raised fear in her. 

It raised memories of a ‘mental’ illness she had experienced in the long past and ‘could well do without’. Mary had begun to feel anxiety, fear and panic. She surmised that the lack of sleep was a major contributor, and one she felt strong enough to redress.

No one would ‘listen to understand’ she said, and ‘so I simply asked John my husband to bring me home. I know I’m being a nuisance to you doctor’ she said apologetically.

And yes I had to rearrange investigations for her - the scanner was luckily working and Mary’s scan normal.