My patient who died

I had a patient on my service who was in her early 70's. She had been living with her family and had been getting progressively more depressed. She felt that she was a huge burden on her family and recently had said that she would be better off dead. She had also been complaining about a diffuse rash that had spread over most of her body that was accompanied with pain. Her family was skeptical of the pain and even the rash at first. The rash was originally hard to see and she had been so depressed that they did not think that the pain was anything to be worried about. 

She presented to the Emergency Room 3 days ago and became my patient. I did a complete work up and ultimately concluded that she had sarcoidosis which is a not so common disease and we do not completely understand what causes it. It usually affects younger people and causes granulomas to grow in various areas on the body. Usually the lungs are affected but the granulomas can form anywhere. Often this condition will grow slowly over time and can ultimately lead to organ failure and death but it can also appear and grow rapidly.

My patient had signs of neurological involvement which would mean that the sarcoid had spread to the brain which would explain her recent depression and atypical behavior. We decided to have her get an MRI today. I was paged this afternoon and told that while she was getting ready for the MRI she began to decompensate and died. I had to go and verify the death and call the time of death. 

I also had to notify the family and to a certain degree they were relieved that at least she had a diagnosis and there was an explanation for her recent behavior. It is difficult to see a loved one deteriorate mentally and the families are always relieved when there is an explanation for the behavior. 

It was an interesting day and a unique case. Every time I have a new case and patient it is like my database of clinical knowledge grows a little. The hands on learning in the hospital is much more effective than just reading about a disease or case. No wonder the training takes so many years, there is so much to learn.