By Tedler D. Depaynos, MD
The 46 yrs. old patient had been having slight chest pains from time to time but with the medicines prescribed by her cardiologist, she experienced great relief. She went back to her usual activities and did some back yard farming. She just harvested a bagful of “sayote” and was walking home when she slipped and fell landing on a rock with her left chest. The path way was obviously slippery because of the continuous rainy weather. She was assisted by her nephews who luckily were around and was brought home.
Initially, she refused to be brought to the hospital because the pain was tolerable. On the 3rd day she was heard softly moaning and despite the rains and the unholy nearly midnight hour she finally consented to be brought to the hospital. They were forced to borrow the Delica of one of her nephews.
On plain chest x-rays, her 7th to the 9th left anterior ribs were “cracked” and a minimal fluid level was appreciated on her left chest which was interpreted as hematoma due to bleeding. Apparently the trauma was severe. The attending MDs were curious why she was not able to protect herself with her arms when she fell for that is supposed to be the automatic response.
Upon further interviews of her relatives, they observed her to be complaining of dizziness from time to time and one of her very young nephews even described her to be suddenly “epileptic”. The older ones disagreed with the impression, however, but it simply means that the attacks of dizziness were obvious. She must have felt dizzy when she slipped and fell which was later confirmed by the patient.
Actually, the patient when she requested to be brought to the hospital, said she was afraid she was having a “heart attack”. She described her pain to be originally bearable when suddenly it was “continuously severe”. She was then referred to her Cardiologist whom she requested who after a brief work-up and evaluation, concluded that her heart is well compensated and functioning well.
Strong analgesics were then prescribed and the patient was then advised to take breathing exercises from time to time despite the pain to expand her lungs because of the danger of developing pneumonia as a complication despite the prescribed antibiotics. Her left hand was placed in a sling and bandages were applied on her chest to help stabilize the “rib fractures” upon body movement.
The problem was the cause of dizziness! The patient was initially not so open but her cardiologist later learned with insistence from her relatives that her attacks of dizziness started when her husband left her again for abroad perhaps for good. She was observed to be missing her meals sometimes and could not sleep. She was sometimes seen sitting down in her back yard garden trying to hide her tears. She appeared “depressed” and apparently losing weight. She was, however, observed to be buying and taking her medications regularly but her cardiologist missed her in her follow-ups recently.
Her cardiologist then took time talking to her. She even visited her in the evening encouraging the patient to talk about her personal problems. The patient apparently trusted her cardiologist wholeheartedly allowing her to do psychotheraphy.
The slipping incident was then concluded to be just a superficial manifestation of her main problem. The “rib fractures” would heal eventually but her “depression” may take some time. A massive psychological support was needed from her relatives and they agreed to bring her back to her cardiologist from time to time whom she apparently have a very good relationship.
It was on the 4th hospital day when the patient requested to be discharged. When the attending MDs made their rounds, she was out from bed smiling with her arm sling and chest bandages removed. She was fully dressed with her baggage ready and she seemed to be no longer in pain. Likewise her dizziness disappeared when she started expressing her problems to her cardiologist.
The medical students were very much impressed with the cardiologist. They learned later that the patient and the cardiologist were town mates and they were classmates and close friends from high school up to college. They only separated because of their different calling. It is obvious then that some “depressed” individuals open up only to individuals they trust and are close to.**
