By Tedler D. Depaynos, MD
It was late afternoon when the ambulance coming from another hospital was rushing with its emergency lights and shrieking siren making the long lines of vehicles give way. An ER personnel suddenly called that the patient the ambulance rushed to the hospital was a colleague who partially retired from our profession and entered the political arena in his province with the aim of expanding the service he dedicated himself to do in a wider field. The caller was very frantic because they were all busy reviving the patient and they were fixing the inserted endo-tracheal tube connected to a machine that was breathing for him. The patient was then admitted into the Intensive Care.
There was a fiesta in the adjacent town and the patient was seen earlier going around, socializing and eating with the gathered people which obviously was part of his political agenda. Late at night, he called a relative that he needed to be brought to the hospital. When the relative arrived he saw him very weak and could not even stand up with his watery smelly waste scattered all around. He was having severe uncontrollable diarrhea. He had to be literally carried and rushed to the nearby hospital he used to be connected with. Since he was living alone, none of those who brought him to the hospital knew when he started getting sick.
Obviously, he was suffering from hypovolemia because of the severe loose bowel movements. Water and Gatorade containers were seen scattered around his place showing that the patient had tried hydrating himself but was obviously not successful. Several I.V. fluids were immediately inserted in an attempt to replace what the patient lost and was losing when unexpected complications were noticed. Due to severe hypovolemia, the patient developed cardiac and renal failure and his level of consciousness was affected. Because of these, he was rushed to a more equipped hospital facility.
The numerous attending physicians did their utmost best to take care of the patient and to control the complications but they could not imagine the super aggressive bacteria that would make the whole gastro-intestinal tract get inflamed in a very short period of time causing it to secrete massive amount of fluid like a free flowing pipe. Obviously, the bacteria could easily enter the systemic circulation causing sepsis which was another entertained complication!
In most cases, when a patient has diarrhea the food intake that caused the diarrhea is also automatically passed out so that within 24 to 48 hours or even 72 hours, the patient recovers. In this patient, the manifestations were rare in the sense that the diarrhea was extremely severe that in just a few hours he went into shock. Cholera was entertained but this is an epidemic disease and those that ate with him should have manifested similar complaints. An elderly colleague recalled that the cases he saw during their student days were isolated and the patients with I.V. fluids inserted in all their extremities were placed in folding canvass beds named “cot beds” used by the military camps before and wide holes were made to accommodate the buttocks of the patients. Underneath the holes were metal pails for the uncontrolled flowing waste. The whole isolated ward was reeking with unpleasant smell and disinfectants were sprayed to eliminate and drive away the flies!
The concerned relatives and friends went asking around who were his table mates during his social visits or if any of them also had diarrhea even at a lesser degree. His refrigerator at his lonely home was even examined for any leftovers that may have caused his severe loose bowel movements. Nothing significant however was found. Unfortunately, the patient was not able to help because he never regained consciousness.
In retrospect, a cardiologist of a lawyer friend who appears to be more elderly and obviously very experienced and because of his many waiting patients sometimes forgets to shave his glistening white beard was heard wondering aloud if this may have been due to food poisoning. The attending physicians were all dumbfounded. **
