Pranab Chatterjee

It means what would Gregory House do?


One of my friends is mortally ill. He contracted a Hepatitis A infection and went down with fulminant hepatic failure, which is quite rare in Hep A infection. Subsequently, he suffered from massive intravascular hemolysis and the resulting hemoglobinuria precipitated and acute renal failure. He was put on the ventilator because he was unable to protect his airway and was having respiratory acidosis. This was followed by development of ARDS about 18 hours after initiation of mechanical ventilation. (This clinical hypothesis is entirely conjectural because I have built this up from the history and investigations that I have seen on him, and I must say it sounds plausible, though not good, by any means.)

Indeed, I was stricken. At times like these, there is only one thing I do. I hide behind an armor of medicalese. It helps me to distance myself from the situation and tide over the feeling of impotent rage that overcomes one who is sitting on his ass watching a friend go sicker and sicker with every passing day.

What helps me at times like these is asking myself: WHAT WOULD GREGORY HOUSE DO?

And for once the answer is forthcoming: become totally emotionally detached from the issue, try to analyze it from the medical point of view and see what previous history tells us. After I got home last night, I went on to PUBMED, Cases Journal, BMJ, etc. and started reviewing Hepatitis A and Fulminant Hepatic Failure and possible outcomes. Most of the cases were complicated by the fact that there were other confounding infections, most commonly Hepatitis B and C which led to the FHF, unlike in the case of my friend in whom the rest of the viral markers came back negative. So, the incidence of an isolated infection by Hep A related with FHF and multi system involvement is rare to the point of being unheard of. I could unearth only one paper from Cases Journal which states a similar profile.

Thankfully, what put my mind to rest was the fact that in all the cases reported, there was, almost universally, a stormy convalescence period, followed by eventual resolution, with zero mortality.

Indeed, reassuring. And to be honest, I could do with some. Beneath the facade of apparent detachment, I was indeed deeply affected by this. For once, Greg House has helped me out.

I pray for him. His family. And hope that he recovers completely. And soon. And I ask you to do the same…

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"WWGHD?" by @bongbuzz