It was a usual fine day when as a medicine resident, I got posted in Coronary Care Unit (CCU) for cardiology rotational training, here I encountered with a patient who had been hospitalized for more than two weeks. I inclined towards this patient after learning sequences of events and surviving the death charm, a couple of time, therefore, I named him the man who lived (the chosen one). Being harry potter ‘s fan, I found the resembles between the two, and how they were alike, will be unfold as you read along.
In my 2.9 years of medicine training, this case was a unique experience for me, rather a roller coaster ride .The rationalize proper approach along with the great passion of the primary attending physician was commendable. He was like the Dumbledore to the analogue of harry, doing all possible efforts to make harry survive.
Without any further delay, let’s begin.
Our patient was middle age male with hypertension as only comorbid, having a good functional class landed up in emergency with complain of chest pain. Arrival electrocardiogram (ECG). showed ST wave elevation in leads suggestive of inferior wall Myocardial Infarction, boom! This is the first death charm, but he had successfully combated it and after percutaneous intervention with drug eluting stent placement, he got rescued back.
However, next day, he had persistent chest pain with ST elevation on ECG , hence went for Re-look angiogram, stent there was found to be patent (he likely had pericarditis associated chest pain).He soon had episode of arrhythmia, ventricular tachycardia, which had lead to cardiac arrest , boom! Death charm strikes him again! But he was our harry for a reason, yes! He again survived after 5 cycles of Cardio Pulmonary Resuscitation (CPR). He was got intubated and post CPR ,went into cardiogenic shock ,he had ejection fraction of 20% with segmental wall motion abnormality( as shown on echocardiogram).Temporary Pacemaker(TPM) got in-placed due to persistent bradycardia with heart rate of 36 beats per minute and intra-aortic balloon pump(IABP) inserted along with inotropic support. The literature depicts more than 50% mortality in cardiogenic shock. He was a warrior, strike back and won the battle against the death. He was got extubated on 5th day post CPR and got out of cardiogenic shock; hence TPM and IABP had been removed. He got mobilized to chair and was improving till dementor (the magical creature in harry potter books) returned to suck the happiness.
Nevertheless, his new life not came with-out a price, downheartedly, he got hospital acquired infection, noteworthy to mention, the ventilator associated pneumonia with bacteraemia. With other systemic effects, he also had got the platelets count lower due to sepsis. He was initially kept on mandatory anti- platelets therapy for sake of stent patency .Alas! he need to payback more to reduce the life‘s debt, as he developed per rectal bleeding. Diagnostic Sigmoidoscopy done at bed side to look the cause and it showed multiple ulcers from sigmoid up-to the descending colon, some of them oozing actively so sclerotherapy was done.
The death angle was smirking in the corner during procedure, i guess, as post procedure he dropped the blood pressure in few hours and after relevant investigation it found to the gut had been perforated. Boom!! This was the third spell by death angle and he again at verge of death tunnel.
It was so painful to saw the family crying, surgeon was reluctant for laparotomy due to more risk and less benefit as he had not enough body reserves ,hence he got managed conservatively .Almost all of our team member (including me) and surgeons team was certain that he would loose the battle this time.
Here its worth to mention that only the primary attending, the commander, had the faith that let him gave a chance with best medical management despite of all odds. His enthusiastic approach and relevant directives were followed by us, the soldiers of his army.
Surprisingly, he again conquer the death. After five days, his gut mobilized and he started tolerating oral food well. He performed bed side cycling for almost more than 30 minutes; it’s showed his stamina and his persistent refusal to surrender.
But, there is a proverb like that the candle shine brighter before blowing off. This was the same scenario here, as he suddenly had increased white cell count, blood cultures were sent and he started detoriated clinically, soon it turn out to be deadly fungal infection in the blood stream. His body got weaken with constant resistance against death charms and he got wounded severely, as his kidney got in complete shut down, liver was got upset too and the heart already had been weaken by myocardial infarction.
The lethal fungal infection started slowly spreads in the body and again our patient was at verge of death tunnel despite the antifungal treatment ,his clinical condition kept on deteriorating, he had longest hospital day more than 40 days and thrice face the death but this time it seemed to be like his body had now surrendered. Nevertheless, no doubt, he was a great fighter and he will remained be in my memory as the harry potter analogue. The chosen one.
May his soul rest in peace.
