Tuesday, May 30, 2006

DoRo

Day 60:

Almost done now... One more day.

Google Video: Robert Newman's HISTORY OF OIL

This innovative history programme is based around Robert Newman's stand-up act and supported by resourceful archive sequences and stills with satirical impersonations of historical figures from Mayan priests to Archduke Ferdinand. Very funny. (45 minutes)

Monday, May 29, 2006

DoRo

Day 'I'm Too Tired to Count':

I was in the hospital every day over the weekend, but I've been too lazy to update. Bah, oh well. Hope you'll forgive me.

My senior partner, Dr. Mike, got married yesterday. Dr. Rees, on the reception: "Mike's definitely a showman. It was.... literally... like a Hollywood production."

An understatement. It was awesome.

His wife's a lucky lady.

Friday, May 26, 2006

DoRo

Day 56:

Congrats to Mike and Amanda for earning their M.D.'s!!

Thursday, May 25, 2006

DoRo

Day 55:

I'm on-call right now. Still waiting for my first 'hit' (new patient).

So far tonight, I've...

a.) gotten the surgical pathology report back on one of my patients, confirming adenocarcinoma of the colon.
b.) read all about the GI system.
c.) taught myself how to shuffle cards.
d.) listened to the guy down the hall sing country songs to himself.
e.) eaten two Snickers.
f.) printed copies of Truman's antibiogram for everyone on the unit.
g.) updated a sticky note.
h.) wasted time on Facebook.
i.) played Nerf-hoop basketball.
j.) built a tower of cards.
k.) done a bunch of push-ups.
l.) tried to build a tower of coins.
l.) checked my email. (L2? - how'd that happen!)
m.) tuned into the Royals losing another game on the radio.
n.) pressed random buttons on my pager.
o.) read about different medical specialties in a book from 1991.
p.) investigated the Canadian Medical Residency Matching System.
q.) listened to music on my MP3 player.
r.) read the news.
s.) run up and down five flights of stairs.
t.) refreshed e-Care 120+ times to see if any new patients are here.
u.) thought about whether I should cut my hair before Mike's wedding on Sunday.
v.) made faces at myself in the bathroom mirror.
w.) tidied up the unit table.
x.) written a silly post for my blog.
y.) thought about the future.
z.) started to yawn.

Wednesday, May 24, 2006

DoRo

Day 54:

Kansas City, MO (AP) - A seven year old boy was at the center of a Kansas City courtroom drama yesterday when he challenged a court ruling over who should have custody of him. The boy has a history of being beaten by his parents and the judge initially awarded custody to his aunt, in keeping with the child custody law and regulations requiring that family unity be maintained to the degree possible. The boy surprised the court when he proclaimed that his aunt beat him more than his parents and he adamantly refused to live with her. When the judge suggested that he live with his grandparents, the boy cried out that they also beat him. After considering the remainder of the immediate family and learning that domestic violence was apparently a way of life among them, the judge took the unprecedented step of allowing the boy to propose who should have custody of him. After two recesses to check legal references and confer with child welfare officials, the judge granted temporary custody to the Kansas City Royals, whom the boy firmly believes are not capable of beating anyone.

Hat tip to Ash for this.

Tuesday, May 23, 2006

DoRo

Day 53:

Wasting time on the unit...

I started stacking cards sometime last week. I was very proud of my original creation, which utilized all 52 cards in the deck.



Today, my technique was a little more refined.



I went a little bit higher.



And finally stopped when I ran out of cards.



Thanks to Vineet & Lauren (in the background) for not breathing while my tower arose from the tabletop.

Friday, May 19, 2006

DoRo

Day 49:

Diana, speaking to Rishi: "Eww, you just touched my face. Now you're going to have to wash your hands."

You'd have to have been there, but man, was this funny.

Thursday, May 18, 2006

DoRo

Day 48:

Okay, first thing's first... Best Music Video Evar.

Next, today's DoRo recap: not bad. Short and to the point.

Finally, an article from the DES MOINES REGISTER - Eighty-year-old Mary Wohlford has informed family members of her wishes should she ever become incapacitated. She also has signed a living will that hangs on the side of her refrigerator. But the retired nurse and great-grandmother now believes she has removed all potential for confusion. She had the words "DO NOT RESUSCITATE" tattooed on her chest. . . Medical and legal experts expressed doubts that Wohlford's tattoo would prove binding, either in the emergency room or in the courts, but they give her credit for originality. "I'll be darned," said Bob Cowie, a Decorah lawyer and chairman of the Iowa Bar Association's probate and trust law section. He added, "There are easier ways to do it than that," such as signing a living will or authorizing a medical power of attorney. Said Wohlford: "I don't believe in lawyers too much."

Wednesday, May 17, 2006

DoRo

Day 47:

Disgruntled. >:-/

Tuesday, May 16, 2006

DoRo

Day 46:

We walked into a new patient's room with Dr. R, our attending physician, this morning and the first thing the 60 year old woman lying in the bed did was size him up.

"OOOOOH!" she exclaimed. "Such a HANDSOME doctor!!"

Dr. R glanced at the items on her bedside table and replied: "I can see you haven't put your glasses on yet."

Monday, May 15, 2006

DoRo

Day 45:

"Anthony, have you seen Mean Girls? It's a movie that tells you how to be a teenage girl. You should watch it."

"I hope you're practicing safe sex, Will. Does anybody have a banana?"

"Are you a Buzz?? You look like a Buzz."

"The inside of a toilet is like the inside of a heart."

"Where are the sticky notes????"

~ Dr. S, whose last day rounding with us was today.

Sunday, May 14, 2006

SNL

A Message from the President - This made me smile.

Friday, May 12, 2006

DoRo

Day 42:

Dr. Kassirer was editor of the New England Journal of Medicine for 8 years. He was today's speaker on Grand Rounds, and his topic was "How financial conflicts of interest endanger our profession." I thoroughly enjoyed his presentation, a tour de force on how financial ties to big pharma are compromising doctors' clinical judgment.

He used the following cartoon to make his point. It pretty much sums up his presentation:

Thursday, May 11, 2006

DoRo

Day 41:

Yesterday night, the other half of our team admitted a 28 year old guy found passed out in a Greyhound bus station restroom, surrounded by needles he had used to shoot up heroin. Apparently, he also had HUGE lice crawling all over him, but I include that detail only for the sake of trying to gross you out.

His chest x-ray revealed large cavitary lesions in the lungs, leading us to suspect tuberculosis. TB is a very contagious disease, and it poses a signifcant public health risk. In fact, it is one of the few illnesses that you can be treated for against your will, as the state has a vested interest in protecting society from the threat you theoretically pose to everyone else. A similar justification allows hospitals to hold psych patients against their wishes if they are expressing homicidal/suicidal ideation.

An ethical dilemma arose for us this afternoon when our gentlemanly patient decided he wanted to leave Truman AMA (against medical advice). Dr. V talked with him for 45 minutes, trying to convince the man to stay, but the patient was determined to leave and would not be swayed from his course of action. The question then became, "Could we hold this patient against his will?"

Because sputum cultures were still pending and the PPD skin test we had placed had not had sufficient time to give us a meaningful result, we had no confirmatory evidence that he had TB, just a strong suspicion. This is apparently insufficient justification to hold a patient against his wishes. The patient was therefore allowed to walk out of the hospital.

All Dr. V could do was ask the man to please wear a mask while he was walking through the hallways towards the exit.

Wednesday, May 10, 2006

DoRo

Day 40:

We admitted a patient from the ER last night who appeared to be in significant pain, a 43 year old female with a history of sickle cell disease. Seeing her this morning on rounds, it was clear she was still hurting, as she was unresponsive to verbal commands and she kept twisting/writhing her body in a peculiar way. Sitting up in her bed, she would rock back and forth, punch one of her arms towards the ceiling and back again, crane her neck from side to side, and occasionally let out a low, animal-like moan. It was an odd sight to witness and I felt for the poor woman, but at the same time, her experience afforded me the chance to learn a new vocab term (which accurately captured the clinical picture on physical exam, in my opinion): "crack dancing," a description of the extrapyramidal phenomena and other movement disorders, uncommon, that can be associated with cocaine use and withdrawal.

Tuesday, May 09, 2006

DoRo

Day 39:

We did sit-down rounds this morning with breakfast from the cafeteria. Nothing like discussing patients' high cholesterol levels while chowing down on biscuits, gravy, and bacon.

Monday, May 08, 2006

DoRo

Day 38:

I had Sunday off, but it was back to the business of saving lives again today. Dr. Syp, our supervising resident this month, paged me this morning and asked if I wanted to do a procedure on one of our patients. I was very excited to get this opportunity, so I instantly said yes.

Getting off the phone with her, I hurried over to the GI clinic, where Ms. C, the woman I wrote about last week, was about to be tapped for a paracentesis. The GI fellow greeted me, along with Ms. C (who, as a side note, is about the sweetest lady you could ever hope to meet), and I donned the proper sterile gear so that we could get underway.

A paracentesis, for those of you unaware, is a process by which one drains off ascites (excess fluid in the abdomen that has accumulated as a result of liver failure) in order to relieve some of the patient's abdominal distention and tenderness. This would be the third time we had drained Ms. C since she came in last Wednesday, and while her condition between admission and today has drastically improved, her time on this earth, unfortunately, is probably best numbered in terms of days or weeks left. All the same, she has been incredibly warm-hearted towards everyone who has cared for her, and that element of patience was reassuring for me as I picked out a spot on her bloated belly to puncture with a needle full of anesthetic.

The GI doc told me what I needed to do step-by-step, and honestly the whole process was not all that difficult to work through. After numbing her skin in the appropriate spot, I used a scalpel to cut a knick into the integument there. After that was done, I threaded a rather large needle/tube contraption several centimeters into her peritoneal cavity, carefully marking my progress by slowly aspirating the fluid contents along the way with a syringe. I hooked the other end of the tube up to an empty glass bottle, and turned the spigot on the device to let the ascites start flowing. And out it came - fast as a California mudslide and the color of rich amber.

For me, the main task at this point was to switch the glass bottles I had filled up with new, empty ones until there was no longer anything left to drain. One, two, three, four bottles... it kept coming. As the liquid neared the top of each container, it would froth and foam, the spitting image of a glass of red pale ale.

Ms. C and I chatted about vegetables and melons and so forth while all this was going on, and after 12 bottles (6 liters) had been put aside, we had tapped her out as best as was possible. That rather significant amount of fluid had accumulated in her since just last Friday, when she had received her last paracentesis.

We stitched her up, cleaned up the room, and wheeled her bed back to the floor. While rounding on patients later in the morning, Ms. C told our attending I deserved a "total A" for the job I had done with her. I certainly wasn't deserving of that sort of praise, but I'll be honest with you - getting a grade like that means a lot more to me than the kind we receive in the classroom.

Phew. I'm tapped out now. Time for bed.

Saturday, May 06, 2006

DoRo

Day 36:

Our supervising resident from last month, Dr. Z, spent a considerable amount of time emphasizing to students the importance of checking patients' MARs (medication lists/nursing notes) each day for accuracy. This might seem like common sense, but it's an easy task to forget (especially if your patient's MAR seems to have magically disappeared during the timeframe you're looking for it).

Long story short, I took this advice to heart, and because of it, I was able to spot three potential errors yesterday afternoon involving two different patients. I alerted our resident, and orders were written to resolve the issues at hand.

And that, in turn, made me feel all warm and fuzzy inside. What's better than that?

Friday, May 05, 2006

DoRo

Day 35:

Was on-call last night. Quite worn out at the moment. Will be back in tomorrow - bright and early. Always exciting. Having fun saving lives. Not using complete sentences anymore. Decided to steal from Danielle again. See below:

"Health Insurance is a bit like a hospital gown...

..you are never quite as covered as you think you are."


True.

Wednesday, May 03, 2006

DoRo

Day 33:

All in the family.

I took hits (meaning new admits) this afternoon with our resident, Dr. V. While he was managing a critical care case in the ICU, first I interviewed a 28 year old african-american male in the ER who was experiencing severe pain secondary to his sickle cell disease. He cried throughout the whole history and physical.

Next, I caught up with Dr. V in the ICU, where he was watching a patient's blood pressure fall dangerously low. It stabilized, and as we left the unit, we ran into the sister and brother-in-law of another ICU patient. This 51 year old man had come in with gastrointestinal bleeding, but we were now suspicious of a fairly advanced cancerous process; Dr. V relayed this information to the family, and informed them that their family member was currently undergoing a procedure to drain the massive pleural infiltrate that had materialized in his right lung cavity over the previous night.

Next, we paged a Spanish interpreter and walked to the medicine floor to speak to a 43 year old hispanic male and his family about his recent diagnosis of HIV/AIDS and what it would mean for them in the future.

Following that, I got started on our second admission of the day, a 47 year old caucasian female who was in the GI clinic. This patient had end stage liver disease, and based on her critical lab values, it appeared she was likely in acute renal failure as well. Even after the GI docs had drained 10 liters of fluid off of her, her abdomen was still quite distended and tender. Very jaundiced, her skin looked as though it had been marked by a highlighter two or three times over.

Sitting down next to her bed on a little stool, I began interviewing her; she kept her eyes closed throughout my questions but did her best to answer each and every one of them.

About halfway through my exam, a nurse came by and asked the patient if she wanted her family members (who were sitting in the waiting room) to come in while I was finishing my interview. The patient thought about this question for a few moments and then kindly asked the nurse that they wait until I was finished. We talked about her DNR/DNI (do not recussitate/intubabe) status and how she had hoped to make it to her mother's house in Florida for hospice (end-of-life) care.

Dr. V arrived at about this time, and we retreated to a side room so I could present my findings to him. It was clear from the labs that had been drawn earlier in the day that this woman was in serious medical trouble and would be unlikely to live much longer without considerable medical intervention.

When we returned to the patient's bed, her family was sitting beside her - a sister and the patient's two teenage daughters. All of them had tears in their eyes, and before Dr. V could even introduce himself, the youngest daughter (maybe 13 or 14) literally ran out of the room.

It was hard to watch.

We proceeded to discuss which treatment options the patient did and didn't want from this stage forward. She refused most of them, after which the sister managed to utter, "Guess we better call Grandma..."

The family didn't have any other questions, nor did the patient, so Dr. V and I made our exit quietly.

After writing up some orders and admitting the patient to the floor, Dr. V let me call it a day, while he hurried off to speak to yet another patient's family about their loved one's diagnosis and condition.

(Side note: I'll be on-call tomorrow night.)

Tuesday, May 02, 2006

DoRo

Day 32:

Today's lunch topic: how strong is the evidence behind different doses of aspirin therapy (81 mg vs 162 mg vs 325 mg) in regards to the drug's antiplatelet effect? Sounds like a wild & crazy discussion, eh?

Actually, I thought it was. We're such nerds.

Monday, May 01, 2006

DoRo

Day 31:

The weekend just a collection of faded memories thrown into the ever-filling wastebasket of the past, I awoke this morning to the washed out hues of an early morning sky. As the eternal trash collector, that orange-red incinerator that endlessly streaks its way across the sky, peaked his head up in the east, I shook off my drowsiness and hopped into the shower. The cold white porcelain of the tub's floor sending a shiver up through the soles of my bare feet, I fumbled with the stainless steel handles of the bath's faucet for a couple of moments before stepping beneath the cascade of hot water that finally came bursting from the showerhead in front of me. As I tugged the curtain closed behind me, I breathed in the warm mist that was now trying to envelope my body, attempting to wrap myself up in the humid air much as I had done with a recently cast aside blanket. Eyes closed, I listened to the patter of a thousand water droplets as they bounced off my naked flesh and the cold shower floor, breaking the stillness of a new day...

Not only the beginning of a new day, this morning also marked the start of my second month on DoRo. Dr. S is back with us for the next two weeks as our attending, and we have a whole new set of residents along for the ride as well.

Who knows what the next 31 days may bring?