By Emmanuel O. Fashakin, M.D., Esq.
Carmona was one of the patients who enrolled in our first medical office on Parsons Boulevard, Flushing New York. Those were very lean days. We were extremely grateful for every new person walking through the door. To make things even better, Carmona had a five year old daughter, and she enrolled her in the practice as well. Soon enough, she brought her mother as well. Carmona told me that she persuaded mom to change her doctor, that our practice was very good.
In those early days, we were grateful to have three for one. That was the situation whenever Carmona came for her medical treatment: she brought mom, who had diabetes and hypertension, and at many visits, her own daughter as well. Carmona was almost an ideal patient. She was a very pleasant woman. Always smiling, never argued. Listened to everything the doctor had to say. She kept all her medical follow-up appointments. Everything was good — until it wasn’t.
The first sign of problem was seeing Carmona come to the practice with flushed face and slurring of speech. Telltale signs of excessive alcohol use. I asked Carmona whether she had started drinking a little bit too much. She denied it. But I checked her blood for signs of alcoholism. Her GGT (Gamma-Glutamyl Transferase) came sky high. Again Carmona denied excessive drinking. There was little I could do in the face of her denials. But then alarm bells started ringing.
Carmona had hypothyroidism. She was very well controlled. We checked her TSH (Thyroid Stimulating Hormone) every three months to monitor the disease. She was always in good shape. However, problems started about the time I suspected Carmona started drinking alcohol excessively. First, she missed her medical check up appointments. And when she came in, her blood test results were way off. Carmona’s TSH level was 152 (normal level is 1 – 4 mlU/L). I asked my nurse to call Carmona in.
“Carmona”, I want straight to the point, “you are still drinking, and to make matters worse, you are not taking your thyroid tablets as you should.” I don’t recall Carmona saying anything, but her mother interrupted me: “Doctor, you are not correct. Carmona takes her medications all the time!” I was taken aback. I thought that the mother should support me to help Carmona overcome her difficulties, instead of covering for her. I turned my chair round and faced mom directly: “Ma, what you are doing is not right. I have explained to Carmona that this disease, hypothyroidism could be dangerous. Carmona will get slower and slower and could gradually go into a coma. If she had infection, and they give her antibiotics, it would not work. She may end up losing her life.”
Sadly, my words were prophetic. Carmona missed her next appointment. We called her to reschedule. She never came. Months passed. Then mommy showed up in the office, with little Elizabeth, Carmona’s daughter, now six years old, sent from school to do her medical examination for the new school year. For the first time, Carmona was not with them. My alarm bells went off. “Mommy, where is Carmona!”
Carmona is dead, mother explained in low tone. Carmona fell unconscious at home, they called the ambulance, and she died in the hospital the next day. I screamed in horror: myxoedema coma! Just as I had feared. The hospital probably never made the correct diagnosis. At that time, it took like 24 hours to get TSH result back. Those were the days before HIE (Health Information Exchange). My clinical notes on Carmona were handwritten in her folder, filed away in our steel cabinets. These days we use EMR — Electronic Medical Records. Any hospital participating in HIE can log in, type in Carmona’s name and date of birth and have complete access to all my clinical notes, and get the correct diagnosis.
You cannot save them all. This one got away, but it was so painful. How do you die from hypothyroidism in America? Failing to take a miniature tablet just one time a day? I shook my head in disbelief. It was a very sad moment. I expressed my condolences to mom. We stared at each other. Nothing more needed to be said. I was sure that she remembered the day she signed Carmona’s death warrant, controverting me, when I confronted Carmona regarding her non-compliance with medical treatment.
Mother stopped coming to us, and we lost contact with Elizabeth as well. But there was a final twist to the Carmona story. Twenty-one years after the death of Carmona, I was in my Flushing office and I pressed the bell for the next patient, and in walked “Carmona”! I almost fell from my seat. Standing in the doorway was Elizabeth, now carbon copy of Carmona — the radiant beauty, the smile, everything! Oh my God. Elizabeth was now a Registered Nurse, she was doing medical examination for her job. Yes, grandma had died. I wish Carmona were here to see Elizabeth fulfill her dream. I wish Carmona had listened, and taken one tiny pill only one time a day!
Emmanuel O. Fashakin, M.D.,FMCS(Nig)
