A 40 year old female patient came in due to a cough that started few hours ago. At last I’m not dealing with diabetes this time, or else, I could already build a sugar factory. It was the usual clinic day, seeing patients one after another, giving words of encouragement, sighing in between, every time someone has a high blood sugar, or reminding again and again when DM complications starts to show. Sometimes it is a thought-provoking combat against the scourge of diabetes. Having this woman in front of me with a one day cough, I thought her case was easy.
Shifting my brain back to General Medicine, we started our conversation and physical exam:
Patient: I started coughing this morning doc. It’s disturbing my sleep. Can you give me my antibiotic for this?
Me: Did you have fever? Difficulty of breathing?
Patient: No I don’t have. But I usually run for an immediate consult and my doctors gave me antibiotic every time.
Me: Well, based on my physical exam, your lungs are clear. You do however have fine tremors, a palpable thyroid gland, though only mildly enlarged, Your heart rate seemed a bit fast, your BP is slightly elevated and… Did you just say it started just today?
Patient: Yes. I always have that seasonal cough and colds. But I have a transplant patient at home.
Me: Oh I see. Then you should get flu shots yearly. We have a lot of vaccinations now for your age. I fear you might develop antibiotic resistance if you keep on taking it.
Patient: Yes I know but I’m running out of budget after all the costs we've been thru. Next visit maybe. I just want the antibiotic.
Me: Yes ma’am, unless there is a clinical indication, I can give you that. What I’m saying is, you might have a thyroid disorder, and your cough might be cardiac in origin.
Patient: But I already have a cardio doctor that deals with my heart. He gave me the medicine for blood pressure. I came to you for the antibiotic.
Me: I mean your present problem may be hyperthyroidism with a thyrotoxic heart disease. It’s a problem in your thyroid gland hormones which gives a problem in your heart. Now if you want some antibiotic lets run these test and lets see if you have an infection.The patient returns after several hours bringing all the laboratory results..
Me: The tests confirmed my suspicion of a thyroid disorder. Here’s the medicine for your thyroid, and here’s for the heart. You take this every…
Patient: I did all your tests doctor, now can I have my antibiotic and attend to a post transplant patient?
Me: You’re a care-giver now?
Patient: Yes, a care-giver, at home, to my only daughter..I don’t want her to get this cough.
Me: May I ask what organ ?
Patient: Kidney. It got injured in a car accident and she’s diabetic, type 1, on insulin since 10 years old.Hearing those, I prescribed her the pill she desperately asked for, allowing my medical principles to bend a little while giving advice on vaccinations and prophylaxis.
When you’re a mother, sometimes you are blinded by the welfare of your children that you wouldn't take any principles and arguments attached to these. She was never interested in her illness. It was her daughter she wanted to protect. Here’s a mother who is brave enough to raise a Type 1 DM child and strong enough to fight for her child’s welfare over her own. Shame on me for not paying attention immediately.
And I thought I wasn't dealing with diabetes this time.
Happy mother’s day to all the mothers in the world.
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