By Tedler D. Depaynos, MD
The patient was brought to the government hospital by their municipal ambulance so that the Covid checkpoints let them breeze thru. Even in the hospital when they arrived, the patient was immediately examined at the Emergency Room (ER) after he and his companions underwent the routinary Covid 19 check-up.
The male patient has been having on and off cough from time to time and he always attributed this to his chronic smoking. When it seems to be persistent, he tries to control his smoking and drinks plenty of water with some “herbal medicines”. In one occasion while waiting for his trip back home in a jeepney station, he consulted a physician with a clinic in a pharmacy nearby and he was diagnosed to have “allergic coughing”. He was prescribed the steroid “prednisone” and he takes this from time to time if his “herbal medicines” do not work. This has always been his routine but this time his coughing appears to be uncontrollable.
He has been coughing on and off for the past 2 mos. and it seems to be worsening. The used to be clear phlegm became yellowish and sometimes blackish appearing like blood tinged. He had “slight fever” occasionally which responded to “paracetamol” sold by their neighboring sari-sari store. According to him he gradually noticed that when he lies on his right side, he had difficulty of breathing so that he constantly lies on his left. Eventually, he has to sleep upright or in a sitting position. It was when he finally felt weak and had difficulty of climbing the stairs where their bedroom is located that he agreed to seek consultation in a hospital. His wife kept on whispering how hard headed he was.
At the ER, the attending MD heard crackles on his right chest which implied “pneumonia”. On his left although crackles were also appreciated, the absence of breathing sounds were more apparent so that the presence of “fluid” was entertained. A simple upright chest x-ray confirmed the diagnosis. No wonder, he was not comfortable lying on his right because the fluid in the left lung was compressing it. Eventually, he had to sleep upright so that by gravity, the fluid goes down enabling the upper portions of the lungs to expand despite the presence of the phlegm.
Although the fluid in his left lung was considered to be a complication of his long standing “pneumonia”, malignancy cannot just be ruled out considering that the patient was a chronic tobacco inhaler. Metastasis from other sources is also entertained because the patient is already a senior citizen for more than 5 years already and the incidence of these unfortunate diseases is higher in this age group. It could be that the infection may just be superimposed.
He was scheduled for thoracic tube insertion to drain the fluid and for laboratory examination. Meanwhile, medicines were given and pulmonary procedures were done to help dissolve the phlegm and to make the breathing of the patient easier. While the result of the culture and sensitivity (C and S) test of the phlegm was awaited, massive antibiotics were given intravenously.
It was very unfortunate that a Surgeon MD was suddenly diagnosed to have the dangerous Covid 19 virus so that an emergency quarantine was implemented in the hospital especially those that were in contact with the surgeon which included the hospital staff. This caused the slight delay of the patient’s procedure and luckily it could be delayed according to the attending MD’s opinion. Only one was allowed to be a watcher of the patient and a niece who is a former OFW and presently a nursing student was selected. The wife who is also a senior and the other accompanying relatives were requested to go home.
The drained fluid appeared “cloudy” which to the surgeon may be due to the presence of pus or abscess caused by the lung infection. Fluid caused by malignancy maybe colored but usually they are clear. A super imposed infection however cannot easily be ruled out so that the lab exam of the fluid is awaited for final diagnosis.
The massive antibiotics were very effective so that much improvement of the patient was noticed. The draining lung fluid lessened in due time and a repeat x-ray revealed an expanded left lung with very very minimal fluid. The draining tube inserted was eventually removed. This could only be texted however to his relatives because they were still not allowed to enter the hospital. When the lab results of the drained lung fluid reported that it was only due to infection and was negative for malignancy, the patient was with super joyous smile. He could recall a late lawyer friend who has not yet reached his senior year who had also a lung fluid despite being a non-smoker. It was due to malignancy and he did not even reached 6 months after diagnosis despite the very extensive and expensive treatment he underwent. His smile was unceasing as he kept on thanking the lord for answering his prayers.
The patient was discharged with home medications and their municipal ambulance again came to bring him home. **
