sick people

Had to work again on Saturday at 6am. Came in, saw my patients, did a progress note, then went to check out labs and found out one of my patients has VRE [vancomycin resistant enterococci] on blood culture. I cant stop washing my hands now....

code blue this morning. patient was in the ICU. 64yo female dying from liver damage. her organs are failing...basically all from alcohol. i couldnt figure out what rhythm she had on the monitor so i asked the intern and she looked at it and was just as confused as i was. After, we spoke to the nurse taking care of her and i asked again, "what rhythm is she in? "nurse replied "she has been in everything. its a medication rhythm. shes basically dead." apparently they were waiting for the family to show up and her pulse was the result of vasopressors. her heart was bradycardic, then tachy, had random PVCs, then went randomly into lots of other rhythms. we left the code because she technically still was alive  but we expected to be there again shortly when she went into asystole inevitably [the second the drugs wear off her heart would stop]. she never coded again while i was in the hospital but i would assume she will die sometime today.

chicken scratch

part of my job every morning is to decipher the handwriting of attendings who have practiced medicine so long that they dont give a shift if anyone other then themselves cant read their handwriting. seriously, its like they do it just to fuck with everyone else. in internal med we get consults with all different specialties so each morning we look in the patient's chart and see what the consult suggests. without fail, every morning i have to get at least 1 other person to get a second opinion on what the note actually says.

2 down!

again, i went into the hospital at 6am on Monday and came out at noon on Tuesday. this was my 2nd 30 hour call and now i wont have any more for the rest of the rotations [2 more weeks.] It actually wasnt a bad night because i got a really interesting case to admit from the ER. this poor guy was having severe back pain, fever, chills and night sweats for 1 month. he had been to a couple docs who gave him pain meds and had even been to the ER to check it out. in the ER they did an X ray which came back normal so they sent him home. finally, he couldnt stand it anymore and he and his wife came back to the ER. we did lots of blood work and imaging on him and when the MRI came back, we saw that he had osteomyelitis in his spine! thats a pretty serious bone infection. he was in so much pain and i felt terrible for him. [side note, it might be TB--Pott's disease-- because he is from Mexico and has had a lot of exposure to TB. thats a pretty rare disease so to see one in my career is pretty cool.]

as i walked out of the ER, i stopped dead in my tracks walking out of the entrance. at the front lobby, i found my 2nd year resident speaking with 27 people [i counted] of all ages. she was talking in a serious voice about an ICU patient who they all came to see. turns out, they were here for their family meeting about wether they wanted to do surgery on their 91yo relative or too let her die peacefully. they were all waiting around and the resident had to tell them the meeting was tomorrow at 7:30am not tonight at 7:30pm. ouch. well, turns out they were all really nice about it but damn, thats a lotta pressure to talk to that many people at once about a patient she didnt know too much about [but acted her way out of that one.]

Tuesday morning, after ~5 hours of sleep, i presented my patient at morning report to all the students and interns. it was a good case. they i saw my patients, wrote my progress notes, rounded with my team, and got the hell outta there to get some sleep.

Dictations

this is the first rotation where we have to do dictations. since this hospital does not have electronic medical records, we have to call a phone service and dictate all of our admission H&Ps and it gets typed out by a service. i discovered on my 30 hour call tonight that its really hard to dictate a note when you have worked all freaking day and are falling asleep on the phone. im pretty sure the person that typed out my note thought i was a complete moron because i stutter and cant spell when im tired. just picture me trying to read and talk fast while trying to keep sense of what is going on with the patient. oops.

Mrs. G

2 code blues this morning.

Another eventful patient I have been following is Mrs.G. A 40-something-yo with no PMH who also has no health insurance and barely speaks English. Shes really sweet and has a very bad case of gallstone pancreatitis. well, this lil lady has been in the hospital for about a 5 days now and had a lap chole to remove her gallbladder. everyday i come in in the morning and say out loud "Mrs G is still here??" she should have gone home a long time ago but her laps just werent right and then surgery didnt want to sign off. after being on a constant drip of dilaudid for her entire hospital stay, I am convinced that we have gotten her addicted at this point. sending her home on vicodin will be interesting.

ps its Saturday December 31st and I had to come in to work at 6am for a half day. lame. at least we get new years day off.

another code blue to start out the day. it seems like they usually occur in the morning between 6 and 8. kinda like earthquakes how they usually happen at night. pt survived.

1 down, 1 to go

i went in to the hospital at 6am yesterday. i left the hospital today at noon. that, just in case you cant count [or are just in disbelief] is a 30 hour shift. i got to sleep for about 4 hours. how did i end the shift? the best possible way...had to do a rectal exam right before i got to go home. like i always say, theres no better way to end a 30hour shift that to stick your finger in someones...