Yesterday in the morning, soon after mass a man was presented to my observation for restlessness and severe dyspnoea. He had a previous diagnosis of pulmonary TB.
When I have seen him, I realized immediately that the patient was dying: He was extremely restless and, when I have tried to make him lay down for my visit, he started gasping and died in less than 1 minute.
I have found myself confused, with a dead body on the floor and with a terrible question in the mind: Is it really TB? Is it possible that TB causes a sudden death?
When I have cooled down a bit, I have made up my mind that it must have been a cardiac death: the patient was very young, in his twenties, but here we have a lot of undiagnosed rheumatic heart disease. I cannot prove it because the patient died before I was able to listen to the heart: so I cannot be sure that he had murmurs.
But the way he was trying to breath was like a pulmonary oedema and he had increased jugular vein pressure together with some degree of oedema of the lower limbs.
But all those considerations are useless. The fact remains that we have come too late and the young man is dead.
Br. Dr. Giuseppe Gaido
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