Tuesday, March 30, 2010

So Inappropriate

Do you ever have a moment when people tell you a story and you're only thought is "wow that's so inappropriate?" Well, today I had one of those moments. We admitted a patient from the ER yesterday. He has pancreatitis. Yesterday, he was swearing up a storm and I kind of thought it was funny. Today, he was obviously feeling much better. He asked if I wanted to hear some stories and he looped in some kind of hook because I thought, sure why the hell not. First he tells me about how he had an Indian doctor and he asked her if she ever scalped white people. She kicked him out of her practice. Then he tells me about one time a girl was taking his blood, and when she bent over her boob went into his hand. What did he do? He grabbed it! He tells me "She wasn't even wearing a bra." I then proceeded to tell him that story time was over. When I told my attending all this he was not amused. And he apologized for making me go in there. The patient didn't harass me so I don't really care. I will know tomorrow though, that I will definitely not let him start telling me any stories.

What inappropriate stories have you heard lately?

Monday, March 29, 2010

My Final Week

I know it's been awhile. First, let me freak out for a second. Match day is less than a year away. Holy shit....how am I nearing the end of my 3rd year?
  Alright some updates: the patient who was hallucinating, the next day when I went to see him, he was lining up all the cords on his body and said "Now if I can just get these lined up, I'll get the clock to work." A couple days later, I saw him again and he told me that he was building a modular home in the room but he and Obama had gotten into a fight the night before about the house. Obama was taking the house away but making him pay $700,000; he was kind though and was letting him do a payment plan. Wow. So the diagnosis: pancreatic cancer. Bummer.....one of the worst cancers out there. I imagine he won't be with us too much longer.
   A 30 something female works out extensively on weekends. She did so a week ago. Monday, she woke up sore. Tuesday, she was feeling pretty weak. Wednesday, she couldn't move the lower half of her body. So she came to the ER. Her potassium was 1.6. That is the lowest value I've ever seen. It's supposed to be between 3.5-5. The next day that I saw her her K+ had increased to 2.2. I said something about it out loud in the dictation room and one of the other doctors was like "2.2 is not high." I was like "Well it was 1.6 yesterday so I'm pretty happy with the 2.2.  By the second day, she was able to walk again. It was one of the coolest cases ever. Not the normal heart attack, congestive heart failure, pneumonia, UTI patient. We had to consult heme/onc, rheumatology, and nephrology. She was gone today when I got there, so I was slightly disappointed but her K+ was up into the 3s.
   Last week, I had a new admit from the ER. He was an older gentleman who had a stroke. I had done his complete history and physical. He was sweet as pie. The next day I went to round on him, and he chewed me a new asshole. He was starving and was NPO because he was having a stress test. I walked in the room and quickly knew something was wrong since he started yelling the second I came in. I asked if he had his stress test yet and he yells back "You're giving me a stress test right now!" Okkkkkkkk. He kept saying he was going to refuse the tests and wither away and die. Drama queen much? And this man was not lacking for some body weight. He probably could have gone a lot longer and not withered away. Anyways, his daughter works at the hospital and she came and found me today to apologize for his behavior. Apparently the nurses called her after he yelled at me. LOL.

Tuesday, March 16, 2010

In Over My Head

Way over... Only one of my patients was still in the hospital so I had to see him plus two more. I randomly picked two more people, and oh man, did I pick wrong.

My normal patient (this is the guy with the abscesses who was in so much pain)- He was obviously feeling much better today because I walked in and he said "Well, hi honey." Normally, I walk in and he's grunting or groaning from the pain. He got discharged today. I'm sad to see him go, but glad that we were able to help.

New patient 1- older gentleman who was admitted for new onset mental changes. This history and physical took awhile as he was slightly confused and would got off on tangents....long ones. I asked if he was seeing or hearing anything that wasn't really there. His response "Well, just once this weekend. I was watching tv and the next thing I knew, the characters had joined me in the living room." LOL, man this could be really good or really bad depending on which show he was watching. So he has a huge pleural effusion which needs to be tapped and drained. And the really bad news: they found lung nodules. That's either lung cancer or mets from another cancer. After I got the news, I went back to see him to talk about the tap and to relisten to his lungs. His daughter asked to talk to me in the hallway and asked about the possibility of lung cancer since the ER dr had mentioned something about this. I was really trying to avoid the cancer talk since I'm the med student, but she brought it. So we talked about it matter of factly. I explained to her that we were unsure whether or not it was primary or mets. It went well, and I'm very grateful for that.

New patient 2- an elderly lady with new onset mental changes. Sound familiar? Yeah it does, but totally different case. She has a UTI (which can cause mental status changes in the elderly), stroke like symptoms, and a metabolic alkalosis. Oh yeah, and she can't really speak. So what does all this mean? I was way over my head. I told my attending that I was overwhelmed and I needed help. She was happy to help and then she became overwhelmed. LOL....We ordered a lot of tests. I look forward to seeing all the results tomorrow.

That's it for my patients, however one more story. One of the other hospitalists found me today and told me to go check one of her patient's feet for clonus (a neurologic symptom). The catch? He's a sexual predator. Her advice was to stay by his feet and prepare for him to say something inappropriate to me. All he did was call me sweetheart. I was prepared for way worse. I went in, checked his feet, and left quickly. No need to be in a room with a sexual predator by myself for more time than necessary.

Saturday, March 13, 2010

Now That's some Real Back Pain

And I thought I had some bad back pain.
Patient- 90some year old man who gets admitted for uncontrollable back pain. Upon some work up, it is found out that he is bacteremic (bacteria in his bloodstream) but no source and a UTI. When someone gets an infection, the source has to be identified and in this case it proved to be difficult. his chest x-ray was normal, his MRI found a severe compression fracture but no cause of infection. We ordered an abdominal CT scan, and low and behold, bilateral psoas abscesses. That would definitely be the cause of a blood infection. Ok what next? They have to be drained. This is done by an interventional radiologist under the guidance of CT. I followed the patient to radiology and was in the room while he was transferred from his bed to the CT table. This might have been one of the most heartwrenching things I have been apart of since starting school. This very elderly gentleman who has a severe compression fracture of his spine and two abscesses in his back which are painful, has to be laid on his side on a hard surface. The process of moving him was just awful. He kept yelling out in pain and saying things like "Please don't leave me in here alone." The procedure went relatively smooth and the dr was able to drain a lot of puss.

On a side note, this guy had been prescribed a Fentanyl patch which is a strong pain medicine that is constant since it's attached to the body. When the nurse went to go change the patch Thursday night, the old one was gone, which means that his pain had not been adequately controlled for a few days.

I'm pretty attached to this patient, so I hope when I see him on Monday, he will be either discharged or a lot better. 

Wednesday, March 10, 2010

Me Likey!

Started at 9:30 today and done around 12:20. Love it. Today was a good day for that since there's a big ball of pressure behind my right eyeball. So I've been on the couch since I got home.

Let's see. ICU lady was still alive when I walked by. Apparently she is hanging on.

A man who probably has the worst luck ever. He developed kidney failure from his high exposure to chemicals in his job. Got a kidney transplant from his son. All of a sudden his abdomen was so distended he thought he would explode. They found a mass in his pelvis that was obstructing his GI tract and his bladder. He gets a colostomy because of the backup of poop in his system. They think the mass is coming from his hip that needs to be fixed. No dr wants to touch this guys insides since they all seem to fall apart. An orthopedic surgeon at our hospital decides to take him on. They did surgery on him yesterday and it seems that this pelvic mass is coming from his hip and it is a calcified hematoma. And that's how he ended up on our service. We're just managing his diabetes and blood pressure. He is apparently going back to surgery to get that hematoma out, but since it's calcified they weren't able to get it out the first surgery. Oh and because of his kidney failure, his adrenal glands are failed, so he has to get IV doses of prednisone for a stress reaction from surgery. Bad luck? I think so. Dr. N has made him one of "my patients" so I'll be rounding on him first in the morning.

Tuesday, March 9, 2010

Internal Medicine - 2 Days In

Well, I'm two days in on my internal med inpatient rotation. Life is already 100 times better. I start later and get home earlier. The doctor that I'm with this week is amazing. She is young, super smart, and very personable. I can't believe how much I've already learned. I feel very fortunate for this rotation. My days starts with getting our census, deciding which patients I'm going to see, go see my patients and prepare my note, find the dr and finish rounding with her, present my patients and go see them together. She told me today that I did a good job, so hopefully all will continue to go well.

And of course my stories.

Patient 1- she's elderly and in the ICU and on a ventilator. She's been there a few weeks and her family decided yesterday to withdraw care. While I rounded on her, I realized that it was probably the last day she'd be alive. I just patted her hand, knowing that her name will most likely not be on my list tomorrow. It's sad, really sad, but she's been miserable and she keeps waking up, feeling her vent and gagging. It really is no condition to live in.

Patient 2- brought into the ER because of coffee ground vomiting and hypotensive. Turns out, she has hepatitis C, alcoholic cirrhosis, and esophageal varices from both her alcohol disease and her eating ibuprofen like candy. She really has to give up alcohol, and she seemed like she was ready to make that move. But she refused a social worker to discuss AA. It's really hard especially since her husband drinks every night. In my discussion today, we talked about her hepatitis C and where it came from. She admits to using drugs and sharing needles in her past. "Well, it's what everyone was doing." Looking at her, you would never ever guess that she was an IV drug user back in the day. I mean, she could have been yours or my aunt. She told me that I will make a really great doctor. It's good to hear that even though I had that type of conversation with her today she was willing to look past my "lecturing" and see that I really care.

Sunday, March 7, 2010

My Last Family Practice Post

It's over. Thank God. Jake visited this weekend, and we honestly just had the best weekend ever. I'm so much happier. And my good news is that our next visit begins in 3 weeks and 4 days. And at that point, we'll be driving back to Colorado where I will be for 5 weeks. 5 weeks with my husband!!! I can't even describe how much of a difference this makes in my daily happiness. I have something really great to look forward to!

Now, onto my last few stories of family practice.

Story 1: a mom is in for a physical and has her 3 year old daughter along. Now this 3 year old is absolutely adorable! She spoke just as clearly as your or I and her conversation skills were amazing. She came over to me and said "I have a secret to tell you." I bent over and she whispered, "I call my mom a banana." Oh my goodness, the secrets of a 3 year old are just the best. She then put up 5 fingers and said "I have this many secrets in my head to tell you." Sadly, I didn't get to hear the rest of them. She also told me that I was "the best doctor ever." Again, I had to laugh since I didn't even touch her. As I've said before, 3 year old kids are my favorite to talk to.

Story 2- I walked into a room and the man says "Wow, you are a lot prettier than Dr. D." I kind of laughed, and talked to him about his high blood pressure. When I went to take it again, it went up, way up. He told me that it was me. Dr. D comes in the room and the patient tells him that the scenery is getting better around here. Dr. D looks out the window and says "Oh yeah the sun is out today." That's not what the patient was talking about. So Dr. D takes his blood pressure and afterwards goes "Well, I must be uglier than the other two because it went way down." LOL.

Up next, internal medicine inpatient. I can't possibly tell you how excited I am to have an easier rotation. I don't have to be in tomorrow until 9 am! Amazing :) These should be happier times around these parts.

Wednesday, March 3, 2010

My Head is About to Explode

As if anyone didn't get how much I dislike this rotation, but I'll just blog about it some more. I got home at 8:45 tonight. I have to meet him in the hospital tomorrow morning at 6:30 am, meaning I have to leave my house at 5:45. Really? REALLY? You know I have a big exam on Friday. Apparently, you don't give a shit. One more day. One more day. Thank God Jake arrives tomorrow night. He's going to have to calm me down because I am strung tight right now.

That's all.

Tuesday, March 2, 2010

Some Sad Things

Today was a day from hell with the transition to EMR. I feel like it was a heavier psychosocial day. So the two combined made for an amazing day.

Sad story number 1- A 72 year old man came in for just a check up. He was just chatting away and then was telling us how his two kids don't come visit him anymore. They've only been to see him once in the last year. He goes "Well, I guess they have their own lives now. No time to see me." It broke my heart. This man is self sufficient in his own place. It's not like he's a burden to his family. Just one of those patients you want to adopt into your family so you can show them some love.

Sad story number 2- a lady who comes in for major depression, PTSD, and anxiety. When she was a younger woman, she was living at home with her family. She was going out to hang out with some friends. As she was getting ready to leave, some friends of the family came over to visit. She quickly said hello, and left. When she got home that night, her entire family was murdered. Great family friends huh? Isn't that just the most awful story in the whole world? I'm pretty sure my jaw hit the ground.

2 more days of this rotation. I can do it.