"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 THYROID STORM.

I'll never forget the patient Roberta Smith, a 35-year-old mother of two who presented to our emergency department with fever, confusion and a very fast heart beat. After a brief evaluation in the ED she was sent to MICU.

As they rolled Mrs. Smith into MICU on a stretcher I could see her problem. Set inside a thin face of smooth and shiny complexion were eyes that bulged like a frog's. A large mass straddled her windpipe and neck veins on either side pulsated rapidly with the rhythm of her heart. She manifested the classic picture of an extremely overactive thyroid gland, so extreme as to deserve the appellation `thyroid storm.'

I examined the ED ledger and x-rays while the nurses put her to bed. The admitting diagnosis was actually pneumonia, with "possible hyperthyroidism" a secondary diagnosis. On chest x-ray her pneumonia showed up as a hazy infiltrate in one lung.

There is no test comparable to an x-ray for diagnosing hyper-thyroidism, which is why the ED doctor hedged his diagnosis. Laboratory confirmation is based on blood tests that take much longer to process than any x-ray. Since hyperthyroidism is rarely life-threatening, doctors always wait for blood results if the patient is not acutely ill. In cases where the diagnosis seems apparent and the patient is toxic, treatment is begun immediately.

I asked Mrs. Smith a few questions but she did not answer. Instead she just stared at me with eyes bursting out of their sockets and moaned: "Ummmmmmmmmmmmmmmmmmmmm. Ummmmmmmmmmmmm."

How had this woman gone untreated for so long?