2 weeks ago I was assigned to a new patient . There was nothing strange about this case and it seemed like a usual community acquired pneumonia in a middle aged diabetic lady who was the center of her family and was responding to her treatment so far especially that her testing for H1N1 INFLUENZA was negative . But by the end of the day the nurses called me as the patient OXYGEN REQUIREMENT increased TO 15L/min. I went to evaluate her and found her in respiratory distress, and confused. We acted quickly and her labs and x ray was worsening and very different form 18 hours ago. We incubated here and admitted her to the ICU. Patient got stabilized but she is still in critical condition.

I came outside the ICU. I found her family looking for answers. I TOLD them what we know so far which is she developed severe community acquired pneumonia most probably because she is diabetic with metabolic syndrome . Then they asked me the “QUESTION “ is she going to die?!. I JUST TOLD THEM WE ARE DOING THE BEST FOR HER and let’s hope it works.

God it suppose to be an infection and it is so unreal to me that patient CAN DIE from just a chest infection in this time of modern medicine??... I STARTED to revise my differentials I retook here history the only thing we know more is that she had some dental implants in a neighbor country 10 months ago ,but there was nothing more helping . I tested her for everything that cause inertial pneumonitis and all came negative except one I thought it was the least possible ,she was HIV positive with very low CD4 , and she got PEUMOCYSTIC chest infection. We changed the antibiotics hoping that she respond. Now I ended up with this very sick unconscious patient on the verge of death and a very loving family wanting more answers.

The eldest son came that day alone looking for her treating team because he believes in his heart that she is dying. He asked me to tell him everything and that he can take it. I was wondering ,how can I tell him about her HIV/AIDS STATUS , should I?!, maybe I should , AS the whole family need to be tested now , maybe it is better if I leave it to TE PREVENTIVE MEDICINE DEPARTMENT and a social worker to handle it , I really wish that she wake up now and call him ...while i was drowning more in my own thoughts,he asked me again what the results of the tests?! . so I told him! The words just came out….and the poor guy just went blank…then said but this is must be false are you are sure you are on the right track here and you are not treating here got a wrong diagnosis , I said we are sure of this , he replied in very frail and hurting voice : how it can’t be ??!!. I just did not find the words he looked at his mom and kissed her in the forehead then said please save my mother ?!. later he left in very complete silence. Then I managed to extract few words and I TOLD HIM to bring his father so he can be tested… "

The patient is dying and showing all the poor prognostic criteria not responding to anything we are giving and now shestart to bleed bleeding from everywhere. The husband came with his son . the husband still does not have a clue , no one told him yet. THIS TIME my consultant was around and he talked to them again the husband took it very reasonably considering the situation he agreed to be tested . They went to visit her . Few days later I knew that the husband test result came out negative . My guess she got it during that dental procedure she had it done 10 months ago…

Today the patient was deteriorating more , and her heart stopped several times ,we called the family to spend time with her. We were all looking at them surrounding their lady of the house slipping away .The women who is always in charge of organizing their life BUT now she is not even able to open her eye to see how much they love her. May be she know that already. Then her heart stopped again but this time is forever. The WHOLE ICU was filled with an overwhilming sadness .Their grieving voices were of all different types but all mean one thing ...that they can not live with out her.

As for me I just felt sorry, sorry they had to continue the rest of their lives without their mother. Sorry for being the one who is connected with the moment that changed their life for ever . I’m sorry that our lives crossed like that . Sorry for not being able to save her. So sorry for them and so sorry for me. All I meant is to help …