Have you ever been scared out of your wits by something a doctor told you? I was asked to see a patient some time ago with a bad rash. She had been hospital for about 2 weeks already, getting 2 antibiotics for a spine infection.
This was a woman of almost 90 years old (though she looked closer to 70 years old) who went to the emergency room for an excruciating back pain which prevented her from walking. She was found to have an infection of her lower spine with an associated spinal abscess. Her blood cultures turned out positive for a strain of Staphylococcus and that was felt to be the cause of the spinal infection.
The patient was kept in hospital for prolonged antibiotic treatment. A couple days before I saw her, she developed a red rash with large blisters to her armpits, below her breasts, in her groin creases and over her genital region. The rash was painful and itchy.
This rash was in the classic areas that we usually see yeast infections in patients who’ve been on antibiotics for a long time; that is, in moist, warm body creases. But, what was different about this rash was the large fluid filled blisters in all affected areas.
Because Dermatologists tend to be busy with more cosmetic issues in the office, Infectious Disease doctors very often get called for skin problems in the hospital. So I got called about the rash. Fortunately, I love Dermatology so I didn’t hesitate to see her.
The rash was as described, quite strange because some of the blisters were so big! I’d really never seen one like it that was only in the body creases. Because of the entire scenario I felt it was less likely an allergy, and most likely due to a yeast infection – an overgrowth of yeast because much of the good bacteria on her skin were killed by the powerful antibiotics she was getting.
The patient was treated with a good dose of the antifungal fluconazole, and though the rash was slow to improve in the beginning, after a week, the blisters were finally starting to dry up.
Additionally, because her strain of Staph was sensitive to almost all antibiotics, I was able to stop the powerful ones she was getting and put her on a simple penicillin type of antibiotic. The less bacteria an antibiotic can kill, the better it is for the body overall, since there is less disruption of the natural balance of the body’s bacterial flora. (Where antibiotics are concerned, stronger does not always mean better.)
After the patient recovered from her rash, we were talking one day and she told me how scared she was about the rash. Or rather, how frightened she became after she saw the reaction of her primary doctor when the nurse showed him the rash. Her impression was that the doctor got a startled expression on his face and exclaimed “Oh my God!”
Of course I don’t know what the doctor said but the patient told me she got scared out of her wits. She told me she thought to herself “my God, this must be it! I must be dying!” She said she was so scared she didn’t even tell her daughter anything about it, until sometime after when she started to recover, and realized she wasn’t dying, but was indeed going to live.
When the patient related her experience to me, it made me ponder about how I talk to patients. As much as I try my best not to alarm patients, I admit that sometimes I may fail in controlling my facial expressions.
I remember once seeing a patient with an extensive infection of his chest wall with a lot of swelling and redness and he was quite sick in the ICU. When I got into the room he wasn’t wearing a shirt and the first thing I said was “Wow! That’s very angry!” The patient told me later on when he recovered and was seeing me in the clinic, how scarred he was that first day after I left his room.
As doctors, we have to strive always to give our patients hope that they can beat their illness, rather than leave them in a state of gloom and doom.
Have you ever been scared out of your wits by something a doctor said to you? Please share in the comments!