Friday, August 15, 2008
Some people are really sick!
Sometimes I don't know what to do. A patient in his late 50s is dying before my eyes. He has had Lyme for 5 years (that we know of). He is barely functioning. His MRI shows extensive brain damage which the radiology says is compatible with Lyme disease. All 13 standard WB Lyme bands are positive. His C6 peptide index is off the charts. He watched his mother die from Alzheimer's disease and knows he is suffering the same fate. He has seen numerous doctors in the past. He has taken courses of Rocephin to no avail. I have tried everything I know and then some. He can't afford a second opinion with a world renown Lyme doc. I am it. Finally I tried a very aggressive approach using 3 intraveous drugs: Rocephin, Zithromax and Flagyl. For the first time he was showing some progress. For the first time he told me he was cautiously optimistic. His energy level was improving and his pain was improving. His cognitive issues were even perhaps a little better. The insurance company cut him off after two months. This treatment is not approved for Lyme disease they told him. He rapidly relapsed and quickly returned to his prior state. He needs a lot more treatment. He can't afford it. He is trying to keep his business (which is failing) and his family going. Every day it takes heroic courage for him to get out of bed, put his shoes on and with unbowed, indomitable determination, push through yet another day. He is dying. We, yes all of us, have given him a death sentence. We have stood by and allowed arrogance, greed, ignorance, pseudo-science, politics and professional bellicosity rule the day. I think about him often. I worry and I fret. There is nothing I can do. Perhaps readers of this blog can help me make a difference. Perhaps nothing ultimately can make a difference for this patient. Perhaps it is already too late. But I am a fighter. I learned it from my Dad- a great physician-who remains my greatest mentor, may he rest in peace. This suffering soul should at least be given a chance. Medicine is about caring; but is also about fighting and hope: fighting for our patients and keeping the embers of hope alive; and never giving up until the fat lady sings. Thanks Dad!