PCP: Classic case of portal HTN

Another busy day as usual; I didn't leave the clinic until after 6:00 p.m. We saw more patients yesterday, but today's cases were more complicated (and we didn't have any help). One of the patients who came today was one of Dr. P's former MAs (medical assistant), a really smart man named T who became addicted to drugs and alcohol and ended up with liver damage as a result. He had a bad case of hepatosplenomegaly (his liver extended several cm below his ribcage), and Dr. P showed me a neat trick where if you lay the stethoscope over the liver and lightly scratch the skin surrounding the liver, you can find the liver margin based on sound. T also had caput medusa several cm above his umbilicus (it doesn't always hover around the umbilicus) and spider angiomas all over his arms. Talk about a classic textbook case. T, having worked as an MA, was more than willing to let me learn from him. Sadly he's on the wait list for a liver transplant, and though he's doing well now, I can't help but wonder how much time he has before his liver gives out on him completely.

We had one patient today who needed a well-man exam, and when Dr. P offered to step outside to let him change in private, he said it wasn't necessary and proceeded to take off his clothes right in front of me (in other words, he didn't care). He also didn't care that I had my finger in his rectum for a whole minute or so trying to find his enlarged prostate (apparently my fingers are too small). Dr. P said that he expected this patient wouldn't mind being my guinea pig b/c he's homosexual and his partner is a doctor, and he was right.

Dr. P had to make a run to a nearby hospital, BGV, during lunch hour (12:00-1:30) but we didn't even leave the office until 12:55. Fortunately a drug rep brought yogurt parfaits to the clinic and we got some to go en route to BGV. In the elevator, a young oncologist saw Dr. P's name and immediately introduced himself, saying that he was a new partner with a group of 3 other oncologists and hoped to see Dr. P around in the future. This was good to see; in a few years, it'll be me offering my name to other doctors in hopes they'll refer their patients to me. We only had one patient to see today at the hospital, an elderly woman we saw last week who developed pneumonia and has a lower left pleural effusion. She'll be okay, fortunately.