Wednesday, May 03, 2006


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.)


At 7:33 AM, Anonymous Sam said...

yikes, these days must be so hard! It takes a very strong individual to deal with each of these situations professionally.
Hope you are doing ok!


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