Little pieces of RK

RK died this morning. He just fell down and his heart stopped. I took care of him for myasthenia gravis. He had a terribly challenging myasthenia. He didn't have the usual findings, because his blood tests (antibodies) for myasthenia were negative. His chest CT scan was also negative. He was very difficult to treat because the medicines didn't work very well. He did well with plasma exchange, but that didn't last very long. I did send him over to Mayo for a second opinion. I'm not really sure that they helped. I tried to send them over to a friend of mine who I think is a really smart neurologist for a second second opinion, but he and his wife didn't want to go. I tried treating him with a few different things, but none of them really helped until we came up with plasma exchange. I really expected him to do well and gain his strength back. I was totally wrong, though. I don't think he died from anything I did wrong. I reviewed his chart and I think I did OK at treating his illness. The only thing I can think of is that he could have had a pulmonary embolus which is a clot in your legs that then goes to your lungs that then causes a low oxygen in the blood which leads to an irregular heart rhythm. He didn't show any signs of a blood clot in his legs, though. Also, he still walked a lot (with a walker) which means that it wouldn't have been sensible to put him on a blood thinner to prevent that. So if that's what happened, then I couldn't have really treated it. He could have died from an aspiration which is when your weak swallowing muscles (which he had) mess up and your saliva blocks up your airways. I was trying to get him strong enough to avoid that, though. I had a pulmonary doctor helping me with his breathing at night, but that doesn't prevent this issue. He could have died from something I don't even realize that is related to his illness also.
He might have died from an unseen heart condition - his death may have been unrelated to the myasthenia gravis that he had. He was fairly young, but he was overweight. I wasn't treating his cholesterol levels or his heart. Sudden heart attacks are very tricky. We're lousy at predicting them, especially the ones that start off with a rhythm problem.
RK was definitely one of the best patients that I've had in my practice. I'm not sure that people think very much about how much the patients give the physicians. I know that a lot of the doctors that I know don't really think about it very much. I think they give the doctors as much or more than the doctors give them. I'm not talking about the money part of the practice: patients (and their insurance companies as a proxy for them) pay for services. That's business. I'm talking about the other part: the people getting together with people and "giving" each other some of themselves. We give people little pieces of us, and they give us little pieces of them. That's what happens when we "socialize". Socialization changes people in this way. It causes "group behavior". I and many of my colleagues work very hard to avoid taking the pieces of our patients that they have to offer; the offered pieces contain so much of the negative and draining parts of us that they aren't really good to "take". It's really nice when there are patients who come in and make up for that by giving us the pieces that are good. Those pieces can sometimes be a truly wonderful gift. Those are the little pieces that make people happy as doctors. Without those, it clearly isn't worth it at all.