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.

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