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.


  1. you're crazy jenny. . . BUT alas, youre going to be excellent. just stay away from sexual predators. PLEASE.

  2. UTIs can cause mental status changes? I did not know that.

    Okay, you laugh at my stories and say you're glad you went to med school?

    None of my patients have visitors from inside the TV or fall into the category "sexual predator." Once again, I'm so glad there are people like you because I could never do your job. :)

  3. Erin- Thank you. And yes, I'll do my best to stay away. Thanks for the blog tag. I need to figure out how to link to people's blogs and I'll post about it.

    Jenny- UTIs...yup. First thing you order on an elderly mental status change is a urine dip. And I literally cracked up at the rest of your post. While your patients might not have strange activities, mine can't kick me and throw me across the room.

  4. Well, they probably COULD...

    But you'd hope they're polite enough NOT to. :P

  5. What's your email - I'll tell you where we are headed!