"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: "We Can't Kill Your Mother" and Other Stories of Intensive Care can be downloaded in its entirety as an e-book from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the e-book or print versions, please go to 1st Books Library and enter part of the book's title or the author in their search engine. Below are the first few paragraphs of CRISIS AND LYSIS

"Doctor Martin, I need some help." The call was from Bill Moody, one of our medical residents working in the emergency department.

"Sure Bill, what's up?"

"There's a patient down here with chest pain, shortness of breath and hypoxemia [low oxygen level]. He's in some distress and I think he might have a pulmonary embolism, or at least that's the only way I can put his story together. He and his wife just came back from Florida. They drove straight through, non-stop, eighteen hours in the car. I want to take him for a lung scan. But I wonder, should I heparinize him first?"

"Don't do anything yet, Bill. I'll be right down."

Well, I thought, here it is again. Pulmonary embolism. One of the most difficult diagnoses to make and treat. The great masquerader, undiagnosed in half the patients who have it. And often over-diagnosed in patients who end up having something else. Difficulty in making an accurate diagnosis of "PE" has long plagued physicians, but nowhere is the diagnosis more bothersome than in the emergency department. Make the diagnosis and the patient must be admitted to hospital. Rule out the diagnosis and, frequently, the patient can go home (maybe the chest pain was just indigestion). Miss the diagnosis and the patient can die.

The mere suspicion of "PE" is enough to engender anxiety in the medical staff. "I thought Mr. Jones might have PE" justifies ordering costly tests at any time of day or night. "I couldn't rule out PE in Mrs. Smith" explains why an otherwise rational physician might start a patient on dangerous blood thinners. And "I missed a PE in Mr. Harris" raises the specter of lawyers hunting you down for the inevitable lawsuit. Doctors who suspect PE often feel caught between the proverbial rock and hard place.