Almost Dying On Christmas Day

This is the case of a 34 year old male patient who was rushed to the ER due to difficulty in breathing with altered sensorium. It was a fight for his life and it was a time when I was caught empty handed as I try to save him from an impeding death without any aid. That unforgettable day happened on Christmas.

The emergency room looked practically like a ghost town. With no patient seeking consult or being treated, the ER nurse had opted to step out of the hospital for awhile saying she has a sudden errand to do at her nearby home. The nursing aide and janitor haven't arrived yet, possibly dead asleep from the previous night's Christmas eve celebration. I was basically all alone. Suddenly a man accompanied by a taxi driver was rushed inside the ER. The man was holding on to his chest, breathing heavily. He was gasping for air. He was restless. He appeared pale. He had cold clammy skin.

I immediately asked the driver, "Ano hong nangyari sa kanya?"

"Di ko ho alam. Nakita ko lang ho sa kalye na ganyan siya. Nagmagandang-loob lang ako na dalhin dito," replied the cab driver.

After putting an oxygen hood to the patient and hooking him to an IV fluid, I turned back to ask the cab driver for more info but he was already nowhere to be found.

I tried to talk sense out of the patient, "Tay, ano hong nangyari sa inyo?"

He could barely speak. All I heard were inaudible sounds. His dyspnea was becoming more intense. He was sweating profusely. His left arm was trying to reach out to me as if he was drowning. I was faced with the dilemma of being alone with no nurse to assist me and with no patient companion to extract history from that could aid in the diagnosis and treatment.

I was thinking of a severe asthma attack or a pleural effusion (tubig sa baga) but his lungs were clear on stethoscope. I was presuming it was cardiogenic in origin, probably an MI (heart attack) but his BP and ECG were normal, aside from the fact that the patient was young. I was speculating of an acute hyperventilation syndrome or a toxic aberration but there was no easy way to find out. I felt like I was in Jeopardy thinking of the right answer to a question that offer little clue where a further waste of time could be detrimental. The patient was becoming more tremulous. His whole body began rapidly shaking. His aura exhibited the face of someone about to meet his impending doom.

In a snap, like a divine intervention, I figured that it might be a metabolic complication. I thought of running an RBS test (random blood sugar testing through finger prick) on the patient. After doing so, the result yielded 20 mg/dl, an abnormally low blood sugar level that could fatally lead to a coma any moment. It occurred to me that the patient was experiencing hypoglycemic shock (a fatal complication of low blood sugar level.) Immediately, I administered a glucose solution intravenously to the patient. It was like magic. What was once an agitated man had relatively regained his normal self as if a demon was exorcised out of his body ala Linda Blair.

"Ano ho bang nangyari sa inyo?" I curiously asked the patient.

Still catching his breath, the patient explained, "Nasobrahan ho ata ako sa pagturok ng insulin. Diabetic po kasi ako."

Apparently, the patient is a type I diabetic who miscalculated his insulin intake, overdosing himself. He was waiting for a ride home coming from a visit to his inaanak when the symptoms appeared. The patient was admitted. His relatives were notified. It was late afternoon when a young girl handed me a box of donuts.

"Dok, tenkyu po at merry krismas daw sabi ng papa ko," the girl who is the daughter of my type 1 diabetic patient said.

As I came to see the said patient at the ward to thank him for the donuts, I saw a happy image of his family: the patient with his wife and his daughter cheerfully conversing with each other. For the father, he probably received the best Christmas gift from God, a second chance in life to be with his family. Back in my quarter, I was thinking that I may also have probably received a meaningful Christmas gift: getting to see the joy in the faces of my patient and his family after that close call.