Started my new rotation yesterday: Pulmonary/Critical Care. It's going to be a lot more intense than ID was. Unlike ID, we actually have patients, sometimes over twenty. So we have stuff to do, every single day. And it's awesome. There are four of us to split up the patients, but it's still enough to keep me busy and thinking. Plus throughout the day there is at least one admission so it's definitely been cool to be able to integrate what I've (hopefully) learned over the past year or so.
Today was quite intense, and a bit frustrating. I've spent enough time at Chicago Memorial Hospital that I now have developed a rapport with some of the nurses, which is always a good thing. I've also had the chance to follow several patients over the course of several months, in several different disciplines. It's been fascinating. Today a patient came in that I had seen for several weeks during my Renal rotation. Patient has a history of bilateral breast cancer with mastectomy, urinary outflow obstruction causing chronic kidney disease and hydronephrosis, which lead to the placement of several stents, all of which became infected. All the while her kidney numbers are shooting up like crazy (of course, the woman can't pee!!!). At this point the nephrologist looks at me and says "Something else is going on here. I'm not sure what but this just isn't right. Something bigger is going on." Later, an ultrasound and a CT demonstrated metastases to the liver. Boom. Cause determined. Patient gets sent elsewhere to resume her cancer treatment, and I go about my business. Fast forward many weeks, and I see this patient's name on our consult list and I just know it cannot be good. As it is, I am not assigned to follow her, but there is probably some counter-transference going on here and I just can't help but feel sad. This is a sweet lady and all the cards are going against her all at once. Suffice it to say the cancer has spread and she's taken a turn for the worst.
Later in the day during clinic I encounter something that I'm not sure whether it should make me laugh or angry. An obese man who is so fat that he cannot breathe simply because he's too fat comes into the office. He's bound to a wheelchair. Who's pushing the wheelchair, ask ye? His wife. Who's fatter than he is, and carrying an oxygen tank around. You interpret that as you will.