Mr. D suffered from the lung disease that killed Evel Knievel -- idiopathic pulmonary fibrosis (IPF). The word "idiopathic" in medicine is a code word that means "doctors have no clue what the cause of the disease can be." As a result, Mr. D couldn't breathe anymore -- his lungs were like a pair of old dishwashing sponges left in the sun to dry. Needless to say, there wasn't much oxygen exchange happening. So Mr. D got a lung transplant -- just one lung because organs are in short supply and that's actually sufficient for someone to live. When you have a new organ, you have to take lots of drugs to keep your immune system down so that it doesn't reject the new heart/lung/kidney, but that also renders you susceptible to millions of germs and bacteria that would otherwise be harmless. So Mr. D came down with a fungal infection -- Aspergillus -- and a bacterial infection -- Pseudomonas.
When Mr. D came to the hospital for a short procedure, he seemed okay. It was interesting listening to his lungs, because his right lung (the "native" one with IPF), sounded like tissue paper crackling. His left lung had normal breath sounds. It was listening to two different lungs in one person. I was immediately struck by how equanimous Mr. D was, especially when I asked him if it was okay for a group of medical students to come by and listen to his interesting physical exam. He was a quiet, scholarly guy in his 50s with graying hair -- the type of patient with glasses and a copy of the New York Times on his bed.
After I switched services, Mr. D was ready to go home when something nearly catastrophic happened. He developed a massive bleed into the space behind his back -- his retroperitoneal space. The bleed was idiopathic. Mr. D landed in the ICU and suffered from acute renal failure --- his kidneys were in trouble.
A few days ago, I saw Mr. D while walking through the ICU and dropped by to say hello. Mr. D looked pale and sick, his head was tilted to one side, but he was still conversant. I nervously eyed a length of tubing filled with blood emerging from his body -- he was on CVVH, which filters the blood and helps out by mimicking the kidney. The doctors were thinking that he might need to go on dialysis for the rest of his life.
"Hang in there, Mr. D," I chirped.
He looked at me with tired eyes filled with weary, stubborn resignation.
"That's all I can do," he said softly.