today was our last day and it was a little anti-climatic. i went in to see Mrs. K this AM and sat and talked with her for much longer than i usually spend with patients. i enjoyed spending time with her.
she had an MRI done and unfortunately, i left before i found out the results because I went to the skilled nursing facility with brooklyn. i saw Mr. V, a patient i followed at the hospital there. after seeing some patients, i went home. i texted Dez in the afternoon and asked about Mrs. K’s leg mass.
“11x9x9cm intramuscular mass compatible with neoplasm.”
it broke my heart.
Friday, January 13, 2012
Thursday, January 12, 2012
best. patient. ever.
in the afternoon we got an admit from the ER so i volunteered to do it. my intern Dez and I went to the ER together and starting to get info on the 80-something year old women that was going to get admitted. this patient ended up being the most fun, spunky, and crazy old lady i have had the chance to take care of. honestly, she was the best patient i have yet. she was hysterical and to be able to reminisce on this great time, here are some quotes:
"im going to start my physical now. its gonna be pretty extensive, im gonna start and your head and move down. is that ok?" -me
Mrs. K gave me a once over and looked a little concerned and then said:
"hell why not. im a bitch on wheels" -Mrs K
"[laughing hysterically] im sorry, what did you just say??" -me
"i ain't no sissy Mary"- Mrs K
"theres a tube in my vagina!" -Mrs K referring to her foley catheter [that was securely in her urethra]
"have you ever tried to make out in an orange field? there is no room to spread out a blanket. no room for any hankey pankey." -Mrs K referring to her first date with her now husband
"now how do you think that transpired?"
"I could use a drink right now" -Mrs K
"oh yeah, what kind of drink are you referring to?" -me
"oh you know what i am talking about"-Mrs K
Nicole got to experience all of this with me because she came out to the ER to help. so it was us 3 girls [2 med students and an intern] just chattin away with this 80 year old firecracker of a lady. we spent upwards of an hour and a half talking with her when we really could have finished everything in 20 minutes. when we got back to the call room, we were all giddy and excited over this fun lady. we told Brooklyn about it and he just looked at our disposition and was very confused “whats up with you girls right now?”
Mrs. K came to the ER by ambulance because she was found by her husband in the bathroom after falling. she was cleared by the ED, having seen that she didnt break any bones on X ray or have any brain bleeds by head CT. but, she did have a large, palpable, non-tender mass on her right upper thigh. the tragic point about all of this is that Mrs. K had dementia and though she was happily married and her husband had been taking excellent care of her, she never got her leg checked out by a doctor. so, we were admitting her for her leg mass, not the fall. this mass could be benign or it could be cancer. all we knew is that it had been there for about a year and it was growing.
i left the hospital that day in the best mood. it was a really fun afternoon. its patients and experiences like this that make medicine fun, exhilarating and tragic all at the same time.
"im going to start my physical now. its gonna be pretty extensive, im gonna start and your head and move down. is that ok?" -me
Mrs. K gave me a once over and looked a little concerned and then said:
"hell why not. im a bitch on wheels" -Mrs K
"[laughing hysterically] im sorry, what did you just say??" -me
"i ain't no sissy Mary"- Mrs K
"theres a tube in my vagina!" -Mrs K referring to her foley catheter [that was securely in her urethra]
"have you ever tried to make out in an orange field? there is no room to spread out a blanket. no room for any hankey pankey." -Mrs K referring to her first date with her now husband
"now how do you think that transpired?"
"I could use a drink right now" -Mrs K
"oh yeah, what kind of drink are you referring to?" -me
"oh you know what i am talking about"-Mrs K
Nicole got to experience all of this with me because she came out to the ER to help. so it was us 3 girls [2 med students and an intern] just chattin away with this 80 year old firecracker of a lady. we spent upwards of an hour and a half talking with her when we really could have finished everything in 20 minutes. when we got back to the call room, we were all giddy and excited over this fun lady. we told Brooklyn about it and he just looked at our disposition and was very confused “whats up with you girls right now?”
Mrs. K came to the ER by ambulance because she was found by her husband in the bathroom after falling. she was cleared by the ED, having seen that she didnt break any bones on X ray or have any brain bleeds by head CT. but, she did have a large, palpable, non-tender mass on her right upper thigh. the tragic point about all of this is that Mrs. K had dementia and though she was happily married and her husband had been taking excellent care of her, she never got her leg checked out by a doctor. so, we were admitting her for her leg mass, not the fall. this mass could be benign or it could be cancer. all we knew is that it had been there for about a year and it was growing.
i left the hospital that day in the best mood. it was a really fun afternoon. its patients and experiences like this that make medicine fun, exhilarating and tragic all at the same time.
Tuesday, January 10, 2012
"i would rather have my patient smoke pot all day then be an alcoholic. pot should be legal, not alcohol. when was the last time you saw a THC overdose come into the ER..." -intern
"We should gang-ascultate him with our stethoscopes."-Cardiology attending (regarding a patient with severe AS)
-Lisa via facebook
"stump pump" -our new OMM treatment....
"We should gang-ascultate him with our stethoscopes."-Cardiology attending (regarding a patient with severe AS)
-Lisa via facebook
"stump pump" -our new OMM treatment....
Monday, January 9, 2012
drug seeking....
every morning we get to the hospital at 6am and whoever is there first prints out copies of the current patient list. then, we sit down and divide out the new patients admitted overnight and keep the remaining ones we have already. today, we had 5 new patients so we all kept the patients we had been seeing and then picked new ones to see, write progress notes on, and follow up on. today, i picked a 37yo F named Brandi [not real name but similar]. i thought her case looked interesting because her CC was abdominal pain and hematemesis [vomiting blood]. i thought it would be a change in the cases i had seen in the past so i said i would take her. after us 3 students divided up the patients, one of our interns [Dez] walked in and we went over who was covering each patient. amongst our conversation went:
“who is taking Brandi?” -Dez
“i am” -me
“hahaha, well good luck because apparently she is a complete handful and is pretty much just drug seeking. i didnt want to take her because i can’t say no so im making A [other intern] take care of her” -Dez
“wonderful” -me
I went up and read the patients chart and the nurses were already talking about this her. she was requesting specific amounts of medication and was very attentive to when she was getting her next dose. she was also making demands of how much and what else to give her because ‘she knew what worked for her pain.’ granted, she has had a couple different spinal surgeries because of accidents and had nasopharyngeal cancer, so shes not completely pain free, but everyone knew the story was a little seedy. especially because she had been vomiting blood “for 3 days, and vomited twice in the ER” but no one has actually witness this...
My other intern [we’ll call him ‘young persian doctor from brooklyn who is obviously from brooklyn’] was my intern on the case. he knew exactly what this lady was up to and knew exactly how to get her on his side and sweet talk her. his mission= get her out of the hospital as fast as we can to free up a bed for a real patient. i tried to give this lady some credit and since i am a medical student and not completely jaded yet, i went in with an open mind and tried to listen as though she really had a problem.
i went into the room and spoke with her and immediately she started crying. she was not rude at all, just very talkative. she was very ‘opioid educated’ as she called herself, since she had been on pain killers for at least a decade. we [all the docs] were sure she was just constipated from opiod use and her abdominal pain was due to a ‘back-up’ and she just didnt want to hear this. she really thought something was wrong. and when i looked at her stomach, i agreed that this could be something more. her stomach looked very distended and firm,like she was pregnant [and she was not an obese lady]. so, i asked her a plethora of questions and decided she may have some kind of ulcer, colon inflammation, etc. She insisted on getting a GI consult and i actually agreed.
when i told the intern he laughed at me. he had already called for a GI consult, mostly to cover his ass because you cant ignore this even though she may be making it up. he laughed because he thought i believed her, which i could of did. so, we discussed it with our attending and we got a GI consult. i was hoping they would order an EGD and sure enough, later that afternoon we heard the consult ordered a abd CT and an EGD.
the abd CT was done in the afternoon and it was clear. “no acute changes or pathology.” “you still think there is something actually wrong with this patient?” -brooklyn asked
“maybe.....” -me
i went up to tell her the results and she just cried more because now she had no idea why she had this pain. then she asked me for a neuro consult for her headaches and a pain management specialist for her pain. at this point, i stopped feeling sorry for this lady. while she talked, i had to force myself to not blow her off and be rude because there was a chance there really was something wrong. but it was very hard to take her seriously when in between questions, she kept saying how much she needs her dilaudid, ativan and benadryl cocktail.
i am keeping faith that she may really been in a lot of pain and that tomorrow the EGD shows something. but, i wont be suprised if it doesnt. she admits that she had a pain pill addiction but says that she ‘doesnt abuse pills because she really needs them.’ partially, this is our [healthcare’s] fault because during all her post op and chemo we pumped her so full of drugs that she probably got addicted, but then again, not all of us constantly pop pills for the pain we feel. everyone has some sort of pain somewhere, it may be chronic or acute, but not all of us need a norco or vicodin everyday to deal with it.
i really hope im wrong on this one.
Saturday, January 7, 2012
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.
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.
Wednesday, January 4, 2012
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.
Tuesday, January 3, 2012
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.
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.
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