49. The Chapel

 

Gabriel S. Turner was a 50-year-old lawyer that arrived with pulmonary edema. A classic heart failure exacerbation: jugular venous distension, lower extremity edema, the whole deal. I was definitely not expecting anything different in his case.

        After reading his chart, I went to his room to meet him. He wasn't there, so I went to check on my other patients first. When I left, I met Peter in the hallway.

        ‘Have you seen the patient from B203?’ I asked him.

‘Not really, I just got here.’

‘Really?’ I gave an ironic look at my watch.

‘Back off, I didn’t hear my alarm ok?’ He laughed.

‘Didn’t say anything, Allen.’ I smiled.

After seeing my other patients, I came back and found Mr. Turner on the bed eating his breakfast. I introduced myself and asked how he was doing.

‘Not bad, dear. I am breathing better now, and my feet are smaller. So things are going well for me.’ He smiled. I knew I would like him right then.

He was still needing oxygen though and his lungs were filled with crackles. Maybe he was just a very optimistic guy. I noticed he was having a hard time eating his bread.

‘Is it too dry? Do you need some water?’

‘No, Dr., don’t worry! I am a slow-eater. If I eat too fast it just gets stuck in my throat.’

He stayed in the hospital for a while. We were having a hard time controlling his CHF, which was no surprise given that his heart looked like a melon on his chest x-ray. Maybe that was why he was having such a hard time eating. Anyway, I went to see him every morning but he was never there! I always had to come back later to check on him.

‘Have you seen Mr. Turner?’ I asked Jane for the 5th time that week.

‘Again?’ She laughed. ‘It seems like he is running away from you.’

‘That is a reasonable guess.’

‘I found Mr. Silva.’ Peter said to me at the cafeteria. I went there to get breakfast because weirdly enough I overslept a little and didn’t have time to eat.

‘Who is that?’

‘Your patient!’ I stared at my plate trying to remember my patients’ names, but there was no Silva. ‘The CHF one.’

‘Oh, S is for Silva?’

‘Yes. Gabriel Silva Turner.’

‘How do you know that?’ I suddenly asked him.

‘We chatted a little. I found him at the chapel today, apparently, that’s where he disappears to every morning.’

‘Wait, what chapel?’

‘The hospital’s chapel. You’ve never seen it?

‘Never.’ I was shocked. ‘How come this hospital has a chapel and I never heard of it?’

‘Well, it shouldn’t be such a surprise, most hospitals do.’ He laughed. ‘Anyway, he told me his mother used to love going to the chapel, and he called her Mrs. Silva.’

Jax arrived at our table and we changed subjects, but I kept dwelling on this name.

‘Silva. Where’s that from?’

‘What?’ Jax asked.

‘My patient’s middle name. Silva. Is that Italian or something?’

‘He doesn’t look Italian to me.’ Peter said.

‘No clue.’ Jax said. ‘Why do you want to know?’

‘I am not sure yet.’ I raised from my chair.

‘Silva. Where’s that from?’ I asked Mr. Turner when I found him back in his room.

‘It’s Brazilian.’ He opened up a smile. ‘My mother was Brazilian.’

‘You’re not?’

‘No, but we used to go there in the summer every year when I was a boy.’

He talked a little bit about his family and it warmed my heart. When I was about to leave his room I turned to him.

‘I heard you’ve been going to the chapel. I was relieved to know that you’re not just running away from me every morning, Mr. Turner.’ We both smiled.

‘Not at all! But that chapel is just the best place in this whole hospital. It’s all about God, Dr. Diaz. He is the reason for every season.’ He said smiling.

It wasn’t until I was eating with Peter again that it hit me.

‘It was Brazilian!’ I said excitedly as I thought of a hypothesis for his intriguing HF while I watched Peter eat his chocolate pudding.

‘Okay. So?’ He was confused about why I was so excited with that information.

‘When I saw Mr. Turner for the first time, I noticed he had trouble eating. He said he eats slowly because he has a little dysphagia. I thought that was because of his gigantic heart, but now I am having second thoughts.’

‘What’s on your mind then?’ He said, trying to follow my line of thinking.

‘Chagas. He is American but he said he used to go to Brazil when he was a kid. And if you think about it, his cardiomegaly is a little too big for regular HF, and his dysphagia might be caused by a megaesophagus.’

‘Wow, wouldn’t it be crazy if he had that? It’s brilliant.’

We ran some tests and the crazy hypothesis became the real one. He had Chagas. And the craziest part? When we told him that he said there were 2 cases in his family! Apparently they went to a region where the reduviid, or "kissing bug", was very common.

Gabriel Silva Turner ended up being discharged a few days later feeling better and we followed up on him at the outpatient clinic. He kept being the same optimistic guy he always was.

The day he left I decided to visit the chapel for the first time. It was beautifully painted and the natural lighting was just so peaceful. I understood why Mr. Turner liked it. I sat there in silence for about 5 minutes, and it was the best 5 minutes of my day. When I was about to get up I saw a little handwritten note on the bench in front of me. To this day I wonder if Mr. Turner had left it there, and I always remember him when I go to the chapel.

‘God Cares.’

…

Want to read more about Chagas Disease?

https://www.sciencedirect.com/science/article/pii/S0185106316301123

Want to read a real case of Chagas Disease?

http://contenido.acronline.org/Publicaciones/RCR/RCR29-2/08-RCR-29-2-Chagas-En.pdf

Clinical Board

 

Asx: asymptomatic; Tt: treatment.