Patient QOTD

"I am mad at the fish. It doesn't want me to eat it."

...how much can on really say about that.

Oh What a Day!

What.A.Day indeed! Today (technically now yesterday) was planted by a seed on Friday afternoon, at 5:01 EST. The registrar's office of my school sent out an email notifying students that the electives available after September (that's in about three months...) would finally be available to book beginning the following Monday. How kind of them to send that out after the office closed at 5pm, for the weekend.

Fast forward to Monday. Every senior student has of course read that email, and is ready to jump the phone lines first thing that morning, including yours truly. I needed three, three, measly little electives and I would be done. I just wanted (granted only wanted, not needed) them to be in Chicago so I wouldn't have to pick up my life any sooner than necessary. One of the many reasons I moved to Chicago in the first place was to avoid doing just that. I wanted to stay in one place for monetary, personal, and stress reasons. So I start dialing. The first three times I'm told the circuits are busy. After that I perused through my emails and found a different number, and back doored my way into the holding queue. I was intercepted by student services, who suggested I leave a message, but I firmly maintained that I wanted to be in the queue. By the time my message was answered and my email request received everything would have been taken. So I waited. I waited a total of NINETY minutes, before I finally spoke with an advisor. In three minutes my schedule was set. I'll recap that for you; I waited ninety minutes to spend three doing my business. I got my last three electives, in Chicago. Woot. It looks something like this.

Early Monday morning I decided that I would be late and just accept having to rush through my notes before rounding in order to get my stuff done, so I left about an hour later than I normally do for rounds. On top of that, my partner, for the fourth day in a row, notified me mere minutes before rounding was scheduled to begin that he was unable to come. His reasons have varied by the day, and apparently it reached a head such that the medical education director called him and said unless he was in the Emergency Room he was not too sick to come in. I honestly could not care whether he showed up or not. I just did not appreciate, repeatedly, not being informed of it until it was too late for me to do anything about it, so half the patients didn't get rounded on until the physician arrived--which is bad. Usually I finish rounding forty-five minutes to an hour before the doctor arrives, and I spend that time either studying, reading the news, or gabbing with my fellow students about God-knows-what. However, I could also be using that time to see more patients.

WTF Mate...

While burning through a chapter of Harrison's in order to make a presentation in as little time as possible (it corresponds almost exactly with the amount of notice I was given to actually prepare it...) I came across this little gem...
Estimated GFR (mL/min per 1.73 m2) = 1.86 x (PCr)^1.154 x (age)^0.203...What schmo came up with this equation??? And why did Harrison even bother to include it in his text book...I don't know about you but I do not carry around a Ti-80something capable of doing exponents just to calculate GFR...esoteric knowledge Mr. Harrison!!!

Renal Exam in a Nutshell

"Hi how ya doing. You're peeing? Awesome. Ok I'm gonna go sort through your 14000 lab results now. Maybe I'll figure out how to tell my attending why your 0.1 drop in magnesium is significant.  TTYL."

Best patient of the day..

"I need clothes to cover up my body!!"

*lifts up gown showing us all the goodies*

Patient has a sitter and a football helmet.

This Makes Me Angry...

An 80-something year old Patient has been at Chicago Memorial's ICU for close to two weeks now. Patient has been demented to the point of being legally incapacitated for at least the last four years. Patient has congestive heart failure, renal failure, and arrived with a collapsed lung because there was so much gunk in the lungs. Nurses have been removing not just secretions, but wads of mucus for over a week via suction, and there's a lot that even the suction can't even get out. Patient has coded, been intubated, was extubated, coded again, intubated again, extubated again, coded again, and has again been intubated. All the while there is NO advance directive from the family, who just sits there and looks at Patient plugged up with tubes. There is absolutely nothing that medicine can do except kept Patient alive by inches. The only way this poor patient will stay alive is via a ventilator (ever try moving hooked up to one of those things?), and if, only if, the lungs happen to clear up Patient will go back to a nursing home to lie in a bed, still demented...

Madness and cruelty! Perhaps it's countertransference, but I would never let my grandmother or either of my parents be subjected to that. 

Long long week

The first week of my Renal/Nephrology rotation has already been more intense than the entire cardiology elective combined. First and foremost there are about 723,645 things that can go wrong with a kidney and each one of them is dependent on a different set of parameters, each affecting a different part of the kidney. The heart is much simpler. It's function is pretty simple, linear. It either works or it doesn't, and most of the problems can be observed by simply following the conduction. The kidney...not so much. Electrolytes that we were never asked to pay attention to in Basic Sciences (oh how long ago and far away that seems) can wreak havoc on the kidney with even the smallest changest. It's interesting, but a real challenge to keep it all straight. Potassium, magnesium, phosphate, sodium, BUN, creatinine, albumin...and the beat goes on.

This week was particularly intense as it is the first week. I haven't been asked to write a progress note or do any sort of real physical exam in months (since OB). The first morning I had to rock my brain a bit (anyone smell smoke?) to remember how to go about it! Then I had to figure out which lab values were more important to focus on (all of them, and none of them are important, completely dependent on the patient), and then I was brought face to face with an attending who can remember about forty-six sets of lab values per patient. I, personally, have difficulty remembering phone numbers unless I've used them more than twenty times...Wednesday my partner couldn't make it, and of course that would be the day we had our highest census. I had to round on, and note eleven patients, and then get pimped solo by the attending. All in all a busy day! I didn't get home until rather late (I left smack in the middle of rush hour traffic, oh goody), and then had to do a presentation. It was a bit of a tiring day and definitely will be a more intense rotation but I am liking being busy again.