Went in at 6am and found out Dorothy, my 86yo patient, went downhill fast overnight. When i saw her yesterdy, she had dementia like she has had for many years but she was still able to respond to my questions. the only problem with her was her morning lab values showed a decline in her kidney function. we got a renal consult yesterday and they decided to leave her in the hospital for one more day. so instead of sending her home we kept her for another night expecting to discharge her today. well, when we came in at 6am this morning to get our patient assignments, our intern told us she was transfered to the ICU. they did stat CT abdominal scans on her because she was complaining of stomach pain. after doing the scan we found out she had cancer all over her liver. it must have been there for a year or so and she hadnt shown any symptoms until now. She was transfered from the medicine ward to the ICU and her family decided to make her DNR.   When we rounded [the first time we did so on the wards] my attending spoke with her son and daughter and they decided to bring her home and give her hospice care.  it was such a quick decline and it left us all wondering how the hell she had been asymptomatic up until now.

After eating lunch, nicole and i went with one of our interns to a skilled nursing/rehab facility a couple blocks from the hospital. our attending helps run it and takes care of lots of patients there. Twice a week he sends his interns [and us] to write progress notes of some of the patients. i did a note on a lady with dementia, arthritis, bipolar disorder, etc etc. She was sweet but had a lot going on. anywho, went spent a couple hours there and left around 3:30. it was the shortest work day i had yet [9.5 work day is short these days].