Living on hospital grounds means many times I still get called in to help with things even when I'm supposed to be off duty. This morning at 4 am I was called for a patient who's Hg was 3.2 (normal is 14). She had 2 D&C's earlier this week and had already received 3 units of blood at another hospital. On exam she had choriocarcinoma extending near the urethra. We made the decision to try to stabilize her by removing her uterus as that was bleeding most, knowing that this was palliative not curative. Thankfully she survived surgery and is now in the ICU. As I talked with her husband afterwards I learned he pastors a church and that they've been trying to get her help for some time. Earlier this week I was called in for a patient in shock who eventually died, her family also had been trying to get her help.
While we have patients who delay seeking help, there are many others that try to get help and just don't. Sometimes I think this is from the cultural tendency to not tell patients when things are bad and to avoid admission that the medical person doesn't know what's wrong. Sometimes this is from the cost of seeing specialists that prohibits poorer patients from being referred. Sometimes I think the infrastructure makes is difficult for health workers to know whom to refer too: there's no physician directory here. Whatever the cause, it still amazes me that many of these patients who ultimately present in shock still survive. And I have to believe that this happens only by God's grace.