This was in the winters of December
2008. Mr A, a close family friend of mine had come from Silicone valley (USA)
to take care of his father who had been diagnosed and operated for kidney
cancer (Renal cell carcinoma) at AIIMS, New Delhi in September 2008.
On that morning, Mr A called me
up and frantically said “Pankaj bhaiya, the blood pressure of papa has fallen
and is refusing to rise. Its 74/40 since late last night. We called a physician
and he has given a lot of medicines and injections. Even after giving 4 bottles
of intravenous fluids, the pressure is still the same. He was absolutely
alright yesterday evening- eating, drinking, talking and joking. What should we
do?”.
I was surprised and confused at the same time. I
had seen him recovering absolutely well after the operation in September and
had resumed his normal routine from mid October. I had also telephonically
conversed with him two days back and he was quite jovial (optimistic as he
always was) and reassuringly fit. So what could have happened so suddenly? Was
he in shock (extreme fall in blood pressure most commonly due to bleeding or
infection)? But there were no obvious signs of any bleeding or infection. I also discussed with the physicians treating
him but they were clueless as well.
Clueless, thinking in all
possible directions. It was a déjà vu situation; a situation I find myself
quite often in. May be I welcome, am always happy and available to analyze
difficult and complex medical conditions or may be I am too nosy (poking my
nose everywhere); whatever it was, my mind was running amok and scanning all
the possible causes of hypotension (low blood pressure ) I could think off.
Suddenly, like a flash of light, it
struck. Could it be adrenals (glands responsible for production of steroid
hormones in the body which play a vital role in maintaining blood pressure); Adrenal
failure because of the metastasis (spread) from the operated kidney cancer
tumour. Since the patient was not in the condition for a CT scan, I requested
Mr A to suggest his physicians to give an injection of steroid (Inj
Hydrocortisone) immediately and evaluate the response. Even if the adrenals were
normal, one injection of steroid was perfectly safe.
One hour later, I got a call from
Mr A. The response was more than dramatic. The patient was sitting and talking
with his pressures restored. Mr A was extremely happy and thankful; but I was
sad and sorry. My heart had sunk. I
couldn’t muster courage to tell him at that moment of momentary joy that the
cancer has come back with a vengeance and has almost reached the last stage.
I said “thank you, take care”
with a heavy voice which he could hardly hear and closed the call.
Cool.
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