Personal Views

The end of a story

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6991.1416 (Published 27 May 1995) Cite this as: BMJ 1995;310:1416
  1. Muntzer Mughal

    Nothing is here for tears, nothing to Wail or knock the breast; no weakness, No contempt, dispraise or blame; Nothing but well and fair.…

    JOHN MILTON

    Six years ago I wrote a personal view article about my wife, Indrani. She died two days ago and I can now complete her story. We were married for 19 years and have a 16 year old daughter. Indrani had suffered from rheumatoid arthritis from the age of 6. We had hoped that her diseasewould eventually burn out, but instead it became more aggressive. Over the years she had had both hips and knees replaced and spent a lot of time in hospital. In the last four years her erythrocyte sedimentation rate was consistently over 100 mm in the first hour and her haemoglobin rarely exceeded 90 g/l. She suffered frequent flare ups of widespread inflammation that would lay her low for days on end. But she kept bouncing back, remaining ambulant with crutches, and recently even took up studying Spanish and flower arranging. That was until 10 weeks ago.

    She then started with crops of vasculitic rashes. One morning she woke complaining of breathlessness, a new symptom for her. Her legs were oedematous and I could hear crepitations on both sides of the chest. A chest radiograph confirmed cardiomegaly and pulmonary oedema. Although the heart failure improved with diuretics, the oedema got progressively worse. Further investigations showed raised urea and creatinine concentrations, low albumin, and heavy proteinuria. The spectre of amyloid was raised. Before this could be investigated any further, she suddenly developed pleuritic chest pain one night, and on examining her I noted a pleural rub and dullness at the …

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