Broken Heart... & Liver... & Kidneys

On Valentine's Day, somewhat ironically, we spent most of the day caring for a patient with a broken heart... and a broken liver... and broken kidneys. Jose, pictured below, is a 57yo male with a history of cirrhosis and symptomatic ascites.

(in case you're curious, his sweatshirt reads: "Apparently I have an attitude problem" : )

Unfortunately, liver disease is not his lone pathology. He also suffers from heart failure. A sampling of his echocardiogram on day of presentation is included here.

https://video.wixstatic.com/video/5cbe4d_dda6b1ec7e6f46e794bfc3ae53bd5416/1080p/mp4/file.mp4

(That fluttering object in the middle of the image is the mitral valve. In a healthy heart it typically will approach- and often touch- the interventricular septum, the vertical linear structure off to the left of the image... in this case, the valve barely opens [i.e. poor mitral valve excursion] and is consistent with severe heart failure)

And, he suffers from renal insufficiency. His creatinine was 2.2.

BROKEN HEART + BROKEN LIVER + BROKEN KIDNEYS

He presented with abdominal distention, shortness of breath, and generalized weakness. He was unable to ambulate. His blood pressure was 60/40 (!). He had large ascites as well as bilateral pleural effusions.

He was immediately placed on our cardiac monitor, EKG and labs were obtained, point-of-care ultrasound was performed. Peripheral IV access was established.

Jose received an infusion of 25% albumin in hopes of improving his hemodynamics and a norepinephrine infusion was initiated for further hemodynamic support. Therapeutic paracentesis was performed and 2.5 liters of ascites was drained. His urinalysis was consistent with a urinary tract infection and he received IV antibioitics. He was eventually able to be weaned from vasopressors.

Ultimately, he walked out of our center smiling and feeling much improved.

We are not oblivious to his exceedingly guarded prognosis. Regardless of where you find yourself on the globe, if you have multiple failing organ systems, you should probably put your affairs in order sooner rather than later. Nevertheless, as a result of our efforts, Jose can hopefully enjoy additional time (hours/days/weeks) with his loved ones.

His story is not shared here to suggest that we definitively "fixed" his multiple issues. Rather his story is shared here to celebrate our center's ability (thanks to your ongoing generous support!) to rapidly identify and treat life-threatening conditions despite being situated in the mountains of rural Guatemala. Jose's Valentine's Day visit to our site is a testament to the ongoing fulfillment of our stated mission:

Deliver World-Class Healthcare

to Our Neighbors in Rural Guatemala

And, in so doing, share God's love with the marginalized patient population with whom we have the honor and privilege of working.

Of note, Jose's hat in the picture above reads: "Dios es Amor" (God is Love) and that seems like an apt way to conclude the retelling of this Valentine's Day emergency clinic visit.

DIOS ES AMOR

top image from monika grabkowska, unsplash.com