The Lady

Now, now, we were back into the ICU again.

This week patient is a lady in her late 30's.

Roughly looking at her, her body proportion isn't right.

Not upper body lower body mind you but left side-right side.

Her right side of the body seems to be swollen and the left side is rather skinny, as in skinny.

Both her hands are dotted with fresh scabs averagely one centimetre in diameter and her right hand looks as if it's pumped like a balloon.

And her face, one look, it seems normal but if you observe, there's difference between left and right side.

Her eyeball is more protruding on the right side.

Usually you wouldn't see a full round iris, but you see that in her, circled with the white sclera.

We were left to find out her data.

She turns out the be very helpful kind lady.

Since Czech is one of world's 10 most difficult languages, we kept asking question that obviously have already been answered by her lengthy explanation before.

She was born with a congenital aplasia of lymph system on the right side of the body and the symptoms started to be noticable when she was 2 months old.

Which means she has been living in that condition for decades, from when she was a baby!

Normally, your blood is filtered at the level of capillary into the tissue to provide oxygen etc.

The filtered fluid is returned back to capillary with half of it is absorbed into the lymphatic system and returned to the circulation at the level of subclavian vein.

Since right half of her body lacks this drainage system, the fluid filtered accumulated in the tissue, which is why she has half her body swollen.

And the fluid also infiltrated her right thorax, she lost the use of her right lung.

Yes people, she is breathing with only her left lung.

With one lung left for ventilation she has respiratory acidosis which is well compensated by the increase in blood bicarbonate level and base excess in her blood.

And the fluid makes its way into her pericardial sac (a bag that contains our heart) slowly over the time, so the sac has time to expand itself.

Thus the heart ain't under so much strain compared to an acute tamponade (sudden filling of heart sac with fluid.)

The latter case develops so quickly that the sac doesn't have time to expand, thus the fluid that went into the sac will compress the heart, disturbing blood flow into the heart and subsequently death, which can be a sudden event too.

The lady only have high heart rate in regards to heart.

And since lymphatic system has some share in immune regulation, this congenital disease left the lady with immunodeficiency, which explains the scars on her hands and arms.

Immunodeficiency means there's no cleaner to eat up any threat surpassing the skin barrier and this causes her itching that leads to vigorous scratching and ultimately the scars.

To help with her immunodeficiency, she has to be infused with 20g of antibodies per month.

Let us jump into economic over here.

A dose of antibodies, which is 10g costs about 12000kc per month.

She has to take 20g per month. 20g = 2 doses.

2 x 12000kc = 24 000kc.

current exchange rate is 1 euro = 24 kc.

Then 24 000kc = 1000 Euro.

With 1000 Euro, I could book a return ticket Prague-Kuala Lumpur.

Add another 60 Euro, I can jump on a flight to Penang.

And I was complaining about the money I have to fork out to go home ~ something that I can choose to skip. It's not like I will die if I don't go home this year.

But this lady MUST have her 1000 Euro worth of antibodies EVERY MONTH, or high changes she'll die of infection.

Ok, stop complaining about money Lina!

I'm pretty sure the insurance or the government is chipping in some money for those treatments but still...

It has been a very warm conversation with this lady.

And with every time that I get into the hospital, I couldn't help but to notice, that all these patients, they have teach me so many things, allow me to see variable of people conditions ~ which mostly are on the downside and show me, that life goes on, and there's nothing that stop them from continuing to live.

I believe, in every of us, how bad the condition is, there's always the silver lining to every cloud.

At least, my patient conditions has benefited me in many ways that even I have never dream about before.