Last night on call, we admitted 2 patients with CHF (Congestive Heart Failure) exacerbation. CHFers are nothing new, but what's interesting is that they are both young. They are both obese, and present with shortness of breath as their chief complaint. The similarities end here, however.
CHFer#1 is an obese African male who presented to the ER with SOB for 1 week. He has a long history of atrial fibrillation/flutter that is refractory to chemical cardioversion. He did undergo a successful electrical cardioversion a few years ago. He has a history of medication non-compliance, but apparently has finally been taking his diuretics and rate-control meds regularly. Last echocardiogram shows marked decrease in cardiac function and an enlarged heart. He is a mild-mannered gentleman who has never smoked, only drinks occasionally and denied any drug use.
CHFer #2 is an obese Caucasian diabetic female who presented to the ER with SOB and difficulty sleeping for 1 week. Symptoms started after she ran out of medications last week. She has a history of methamphetamine abuse in which she snorts about $20 worth of the drug every day. She stated her last use was 4 days ago. Her last echocardiogram also shows marked decrease in cardiac function. In the ER, she threatened to leave because no one is taking care of her difficult sleeping, and was uncooperative to the ER staff. At one point, she refuses diuretics, saying that she wouldn't able to sleep if she has to pee every 30 minutes. A Foley catheter would have solved this problem, but she refuses as well.
It is easy to feel pitiful to CHFer #1 because of his pleasant manner and overall tragic history, and as the same time feel angry towards CHFer #2 because of her "obnoxiousness" and her apparent "she has done all this to herself" history. A family physician is all about caring and solving his patients' medical and social issues, but what do you do when your emotions affect your desire to help your patients? What do you do when your patients don't meet your expectation?
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