July 25th, 2010
So today I was off. I got home yesterday around 330pm post call, did a few things at home and by 630pm I was in bed, exhausted. I slept till 340am and it was nice knowing I was off today so I slept till 6am. I went to the hair dresser, got braided, came home took a nap and then started reading. It’s good to read, reenforces.. anyway, I had a patient who came in, 50 something year old with ESRD on hemodialysis. BP was 245/135 and HR 122, his pupils were so constricted I could not even do a fundus exam. When he arrived his mentation was intact, slight headache and nausea; nothing too alarming. First CT was negative but later during the night he became confused, combative, had to be placed in restraints.
I spoke to my attending who wanted a repeat CT, consulted ICU which was good because he needed ICU care. Being a novice I ordered “CT brain stroke protocol” not realizing that an order like that would activate the stroke team….ooooops. My resident shouted at me. Oh well, I figured no harm was done, my guy got his CT pretty fast:) At least now I know, I am there to learn and so I made a mistake but it did not put the patient’s life at stake. So, will be on call again on Friday, Q5 is not so bad this month. Retiring early today, have a good rest of the week to all.
I was very happy to finish my internal medicine rotation. Residency changes you, and if you are not grounded and mentally strong, you end up bitter. Surgeons have a stereotype of being arrogant, mean and difficult people to deal with. I have worked with some of the best surgeons in the world who do not fulfill that stereotype. When God is a part of your life and you are grounded in Christ, you fare better in the trenches.
July 29th, 2010
So time really flies when you are busy. I am chronically exhausted now. Call comes to quick, I was on call on Wednesday and it was busy. I am on call again tomorrow, this is my last week on internal medicine.
My last call, I admitted a 50 something year old with Stage IV lung cancer, mets to the brain and left femur. It’s so sad, he is in so much pain. He is not ready for hospice yet, still fighting, which makes it so difficult because his blood pressure is 90s at its best and the minute you give him dilaudid for his pain, he drops to 70s. I hate to see him in pain (he’s already on 100mcg fentanyl patch, ER morphine 30mg every 8hrs), but dropping pressures into the 70s for someone who is full code makes me nervous. He is now getting palliative radiation therapy to his femur, he’s not stable enough for chemo but he is not ready for hospice.. so sad..
My other patient is a 30something year old male status epilepticus, he got valium 10 on the ambulance without resolution, a total of 16mg of ativan in the ED and was loaded with 1gm dilantin.. CT showed a brain abscess.. this guy was shot in the left eye in the late 90s when he was 20 years old and somehow the fracture he had predisposed him to this…….craziness..
One of my interesting patients is a 30 something year old female with scleroderma, sarcoidosis, severe pulmonary hypertension.. On physical exam she had a very loud P2 and a pansystolic murmur that increased with inspiration. It’s so sad, here she is young with her life ahead of her and can’t walk to the bathroom without being very short of breath…..So, I had a guy in his early 90s, generally healthy who was put on lasix, HCTZ, lisinopril by his cardiologist two months ago for increased bilateral lower extremity edema. When he went to see his doctor for dizziness, his BP was 80s/40 so he was sent to the ED. The guy when I saw him was dry as a bone. His Cr was 6.1 BUN 87.. This is one of those success stories that makes you smile all day; we discontinued all his diuretics and ACE-I and put him on IV Normal Saline at 150cchr, In 48hrs his Cr was down to 1.2…. It was nice!!
So this morning I get up at 630, get ready for work and go to the hospital in my jeans and a nice brown top. I was thinking it was going to be a relaxed day, afterall it is sunday. I arrive a little before 8, get my coffee and hear a code blue being called over head. I just about dropped my coffee when I realized it was my patient. I ran up the stairs to the seventh floor and low and behold the on call team was coding my patient. She was in her 90s, but her daughter wanted her to be a full code. Three days ago she stopped eating and I was pushing for family to reconsider her code status as she was deteriorating, but it’s ok, they wanted everything done for their mother who was almost 100 and we respected their wishes. Today was my first time talking to family about death face to face as a physician. In this case, the daughter was glad that we did everything we could for her mother. It was sad and I cried too, I felt for her; her mother was her best friend. Life is full of pain…..
It’s been great learning, I am feeling a little more comfortable, it’s amazing what almost 4 weeks of intern year will do for you, it seems as though I have been doing this for months…So, off to read. Ciao..until next time my friends.