Sickly Man Stops Meds to Spite his PCP; Admitted to ICU in Critical Condition

7grandpa4 year old Jerry Kilgarten, a long term sufferer from COPD, CAD, CHF, DM, HTN, and other chronic disease acronyms, recently had a falling out with his primary care doctor. On a recent visit to his primary care doctor, Internist Dr. Alphonso Raine, he experienced what he described as a “travesty of service.” For starters, Mr. Kilgarten had to wait 30 minutes after his scheduled appointment before being brought back and another 30 minutes to be seen! 60 minutes late….this was an outrage! After his consultation with the physician, where he grudgingly admitted excellent care was provided, he was not offered enough free samples of his hypertension medication to last a whole month, as apparently their supply was low that day. Then he walked outside to get his car and he was ticketed for parking in the wrong space! After all of these perceived injustices, Jerry vowed to achieve vengeance in the only way he knew how: by passive-aggressively ignoring the totality of his doctor’s advice. “That will teach him and his staff,” he thought, “they will be sorry they messed with me.”

After this visit, Mr. Kilgarten decided to increase his cigarette use to two packs a day, up from one pack. Additionally, he decided to increase his fat and salt intake, to quit exercising, and he decided to immediately stop taking all of his medications, including his long-standing diabetes, CHF, and hypertension medications. His plan was that by acting in such a fashion, that Dr. Raine would feel so bad about his actions by him and his staff that he would feel motivated to apologize for these perceived injustices. In the meantime, Jerry considered looking for another doctor but never really got around to it.

Unfortunately Mr. Kilgarten’s idea was not quite as successful as he had planned. Slowly over the next couple of weeks, Jerry began to develop polyuria, polydipsia, bilateral leg swelling, and then shortness of breath. Finally, Mr. Kilgarten had a severe episode of chest pain and diaphoresis with radiation to his left arm associated with vomiting and his wife then decided to call EMS. Upon arrival to the emergency department, Jerry was found to have ST elevations on his EKG and he was diagnosed with a myocardial infarction. Additionally, his blood sugar was over 500 with an anion gap of 40 and he was found to be in diabetic ketoacidosis. Finally, he was found to be exhibiting severe pulmonary edema and eventually he had to be intubated, placed on two pressors, and started on an aortic balloon pump for what was diagnosed as cardiogenic shock. He was admitted to the catheterization lab where he had a stent placed and subsequently the ICU where he was placed on an insulin drip. He remains in critical condition in the ICU.

As for Dr. Raine, when reached for comment, he only had this simple reply: “I wish Jerry a speedy and complete recovery, but, quite frankly, he is a moron.”


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