The Case of the Blue Man

smiling older guy in hospital bed 1147975604 21Dec2020
Feeling Much Better

The Case of the Blue Man – Help or Die

Jennifer was in tears, sitting alone in the breakroom, when Dr. Darko walked through, taking a shortcut to his office. He stopped, of course, and sat down to ask what was wrong. “Nothing”, she said. That clearly wasn’t true. He gave her a puzzled look. “It’s nothing, or at least nothing that anyone can do anything about. My best friend’s dad was admitted again this morning to the ICU with end-stage COPD. They don’t know if he’ll make it out of the hospital this time. He’s a nice guy, a great dad to her, it’s just so upsetting.” Dr. Darko thought to himself, “That reminds me of the case of the Blue Man.”

Don’t Want an Audience When You’re Sad, But There They Are

By now Marshall had come in for a cup of coffee and also asked Jennifer what was wrong. As he sat down next to Dr. Darko, Nora, Jack, and Diane came rumbling in laughing and boisterous. They quickly hushed when they saw Jennifer crying and a somber Marshall and Dr. Darko sitting there. Everyone sat down. Now Jennifer was even more embarrassed. “It’s nothing,” she said again. No one responded. The six of them sat there, seemingly each waiting for someone else to say something. Jennifer was still sniffing and red eyed and everyone else serious and sad and not quite sure why. Jennifer was ill at ease and the group and the quiet were making it worse. Dr. Darko decided to tell a story to perhaps ease emotions, the Case of the Blue Man.

Do Blue Men Always Come After Hours?

It was a late Friday afternoon and most of the outpatient clinics were closing. The doctors were heading over to the hospital to start their late afternoon patient rounds and the nurses were heading home. Or at least, heading out to join the traffic jam on the freeway on a Friday, hoping to get home at some decent hour. Dr. Darko was at his desk finishing medical record notes from the day before he went home. Suddenly his admin rushed in, surprised he was still there but desperately happy to find him. The Head of the Pulmonary Division was on the phone and very firmly asked to talk with a psychiatrist. And, everyone else had already left. “He’s on line 4,” she said.

The Case of the Blue Man: The Risk of Staying a Few Minutes Late

Dr. Darko picked up line 4 and spoke with the internationally renowned pulmonologist who was Head of the Division of Pulmonary Medicine. He said the wife of a patient of his just called and told him her husband was so depressed he wouldn’t eat dinner. The patient was well known to the doctor, a patient of many years. The chest doctor had never seen his patient this terribly depressed. He thinks something is gravely wrong and wants him seen by psychiatry as soon as possible, that is, seen now. Dr. Darko was the Division Head of the Division of Psychiatry in the Dept. of Medicine, and the pulmonary guy was pleased he had reached psychiatry’s top doc.

For Whom the Clock Ticks

Dr. Darko asked the pulmonologist how soon the patient and his wife could arrive at the clinic. “I’ll call her back and ask, and call you right back,” was the reply. There was an on-call psychiatrist for the weekend, Friday 5:00 p.m. until Monday morning, 8:00 a.m., and it was not Dr. Darko. But he knew the chest doc wanted the Division Head to see the guy, not “doctor whomever” on call. About 10 minutes later the Division’s back line rang, Dr. Darko answered it. All the clinic offices had already closed and the admins had gone home. The chest doc knew the only line that would be answered would be the back line. “They’ll be here in about half an hour. They live close. Call me at home if you need me.”

Time and Time Again for the Case of the Blue Man

The chest doc hung up and Dr. Darko glanced at the clock. It was 5:50 p.m., so maybe they’d be here by about 6:20. If he’d known at the outset that it would go that late he might have tried to pass the consult on to the on-call psychiatrist. But, he felt committed at this point. He swung his chair around, put his feet up on his desk, and pulled out his iPhone. He’d try to find some productive way to kill time. The clock kept ticking, and 6:30 rolled by. Then it was after 7:00. He had neglected to get the patient’s name. So he tried to reach the pulmonologist but he’d already left the clinic and wasn’t home yet. As he started to dial the doc’s cell phone when there was a knock at his office door. He glanced at the clock, 7:20 p.m.

There’s Depression and Then There’s Respiratory Depression

Dr. Darko put on his most friendly gracious smile and opened his door. There stood a concerned older woman, really well dressed, standing behind one of the clinic’s wheelchairs. In the chair, slumped, was an older man. He looked much older than she but perhaps because he was so ill. “Hello, doctor. This is my husband, Sol Kovitz,” she said. He invited them into the office. The lady was hesitant. If he’s seeing a psychiatrist shouldn’t she wait outside. “Well, maybe. First let’s see what this is all about,” said Dr. Darko as he again invited them both in. The lady took a seat in one of the office chairs after she wheeled her husband in and set the wheelchair brake. Odd to set the brake on a level floor in an office, but she had set the brake, nonetheless. The old guy still had not said a word.

Why This Is Called the Case of the Blue Man

As Dr. Darko sat down, the lady began talking. She was talking fast, a mile a minute. She seemed to be trying to get everything out at once, her husband’s recent hospitalizations for chronic obstructive pulmonary disease (COPD), his smoking history, he recent changes in medicines, he wouldn’t eat a bite of his dinner tonight. The patient still had not said a word, sitting slumped and bleary-eyed in the wheelchair, breathing hard and wheezing a bit as he sucked air. He had the tell-tale “barrel chest” of a person with long-standing COPD. Dr. Darko was trying patiently to await the lady taking a pause to breathe so that he could talk to the patient. He was getting more and more concerned about the guy. He was blue, a kind of greyish-blue ashen color. And not just his lips and fingernails. He was kind of blue all over.

Unable To Say Much Speaks Volumes

Once he had the guy’s name, Dr. Darko tapped the keys to call up his medical record. Finally his wife took a breath. “How ya doin’, Mr. Kovitz?”, asked Dr. Darko. The man stared at him with his watery eyes. He tried to speak but a few specs of yellow-green gunk came out of his mouth. Dr. Darko jumped up with a Kleenex for him. And took Mr. Kovitz’ pulse. Thin pulse, thready, fast, and faint. He didn’t need to throw a stethoscope on the guy’s chest. He could hear the wheezing and bubbling without one. His feet were swollen, so poor circulation. “Mrs. Kovitz, we’re taking a little walk,” said Dr. Darko as he opened the office door, swung the wheelchair around, and headed out.

Could Be Emergent, Could Be Urgent, Either One is Enough

Off they went, Dr. Darko pushing the wheelchair, Mrs. Kovitz trailing behind, Mr. Kovitz still slumped and blue. They went across the huge, open lobby, down a long hallway, and turned right, right into the Emergency Department. Dr. Darko spoke with the nurse at the front desk. “I don’t know if Mr. Kovitz is depressed, but I’m sure he’s in respiratory failure, a bigger problem at the moment.” The nurse peered over the desk at Mr. Kovitz, looked startled, and ran back through the ED. Moments later Dr. Steve Ruderman ran out. “Hi Denny.” “Hi Steve, I think I’ve got a sick one here”. Dr. Ruderman laid his stethoscope on Mr. Kovitz’ chest and felt his pulse. He grabbed the wheelchair and headed into the ED, shouting over his shoulder, “Have his wife check him in. He’s urgent.”

Peace At Last, He’s In Good Hands

Dr. Darko sat with Mrs. Kovitz for a few minutes to explain that her husband was being admitted to the Emergency Department and likely would be admitted to the hospital. The admission staff then came to talk with her and get her husband’s information. He was well known to them, so all was going smoothly. Dr. Darko said goodbye to Mrs. Kovitz. He told the ED staff that he was heading out but they could phone him if questions arose. On his way back across the lobby to his office he glanced at the clock. 8:40. He sighed. He hung his white clinical coat on the back of his office door, grabbed his car keys, and was on his way home.

The Happy Ending of the Case of the Blue Man

The next day Dr. Darko called the Emergency Department to check on Mr. Kovitz. He’d been admitted to the Intensive Care Unit the night before. He was stable. On Monday he ran into Dr. Ruderman in the doctor’s lunch room. Steve told Dr. Darko that he’d saved a life. “Another hour or two without pulmonary suctioning and mechanical ventilation with supplemental oxygen and he’d have been dead. As it is, he’ll be home in under a week.” He added the question, “What happened that you brought him in?” Dr. Darko explained that the Head of Pulmonary sent him to Psychiatry to treat his depression, and they both had a laugh. Clearly, depression was not his problem. Over the next couple weeks Dr. Darko saw the Head of Pulmonary in the hallway several times. The pulmonologist never mentioned Mr. Kovitz.

Back to the Breakroom and Jennifer’s Friend’s Dad

By the end of the story Jennifer was no longer in tears, though still upset about her friend’s dad and his end-stage COPD. The thought was there that if the blue man could make it from half-dead to home, maybe her friend’s dad had a chance, too. But COPD is a true worry. COPD is the 3rd leading cause of death in the U.S. The story over, Diane, Nora, Jack, and Marshall drifted off, carrying their coffees, sodas, and snacks. They tried to offer Jenny some comfort, wishing her friend’s dad well and hoping he makes it out of the hospital again this time

Helpful links:

Mayo Clinic on COPD

National Heart, Lung, and Blood Institute on COPD

The COPD Foundation on COPD

COPE Foundation on Living and Coping with COPD

The Lung Health Institute on COPD and Depression

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