The Friend of the Elderly

A wise physician once told me that pneumonia was the Friend of the Elderly. Being a young, naive med student, I didn't understand. As a battle-hardened ICU doc I understand perfectly. Pneumonia is the friend of the elderly because it helps ease the transition from this world into the next.

This last two weeks we had a veritable Quaker Meeting of the Friends of the Elderly. In the space of 2 weeks we had four cases of severe pneumococcal pneumonia, the classical pneumonia. The patients ranged from about 60 to 85 and presented with severe fulminant illness requiring ICU management, including mechanical ventilators, central lines, multiple pressor drugs, broad spectrum antibiotics... the whole show.

One recovered well, two died within a couple of days and one lived to transfer out to the medical ward, but has severe complications, will likely lose one or both legs to gangrene (a complication of fulminant sepsis), and at best, will live the remainder of his life in a nursing home. ICU Doc one, Angel of Death 3.

Pneumococcal pneumonia used to be easily treated with simple penicillin, but now resistant bacterial strains have emerged and we have to use new wave antibiotics. Despite our best efforts, some 25 % of these patients die. This sounds bad, after all, why can't we cure a simple bacterial infection? The thing is, everyone dies of something. Overwhelming pneumonia isn't a bad way to go, and is often pretty quick. As I said, the friend of the elderly. If I can help some poor patient leave this world in relative comfort then I feel I have done my job.

Maybe the Angel is my friend.