IM: First Day Call

Ahh...how nice to sleep until almost 7:00 a.m. =) All my patients got discharged yesterday, so I rounded on Annie's patients before meeting the rest of the team at around 10:00 a.m. Keira let me present one patient to our attending (who was here for the weekend), but when I started rambling (since I'd just picked up the chart this morning) and not knowing what I was talking about, Keira quickly took over. *sigh* The attending didn't even see the patients, just took notes on them and left. "That's it?" I wondered. After rounds, I was free to myself from about 11:00 a.m. to 1:00 p.m., where I stayed in the library so that Sherif could reach me if a patient came (I forgot the cell phone again). I grabbed lunch at the cafeteria downstairs; amazing how much a $7.50 ticket can buy =)

The first patient I saw was a 79 yo lady with a two-day history of nausea and vomiting that's most likely GERD-related; we're keeping her for 24 hrs to see if it resolves. Keira let me write the admit order, which took a lot of thinking and confusion on my part, but I'm glad I got to do it b/c it got me thinking more about what to do for the patient. Sherif, too, asked me the differentials of nausea and vomiting associated with stomach pain, and I named several that we were able to rule out with the Chem-14 alone. My next patient was an 82-year-old man with altered mental status and a-fib. When I went to ask him what brought him to the hospital, he yelled, "I have no strength!" and either couldn't hear me or refused to answer my questions. Keira and I managed to get more answers from his son, but not much, since this man lives alone (son lives in SC) and had fared pretty well until recently, so no one knew what meds he was taking or what medical problems he had. We didn't know if his a-fib was new or old, what allergies he had, or what medications (if any) he took for HTN. *sigh* So he was a challenge for everyone. My last patient was a 74-year-0ld lady who has had bleeding from her rectum for 4 days; she knew this b/c there was blood on the toilet paper and in her underwear, but she never once looked in the toilet bowl to see how much blood there was. Then she'd say that she had diarrhea and increased frequency in bowl movements but when Keira asked her how many BMs she had, she replied, "One." Apparently she tries to "hold it in" b/c having to see bloody toilet paper freaked her out. She also had a long history of abdominal cramps in the morning after drinking coffee and eating sweet things for breakfast, cramps relieved by defecation, yet morning after morning she eats the same stuff despite the pain. Heck, even I get sick having coffee on an empty stomach (my Corpus roommates can attest to that), so yeah, she was kind of nuts too. Later, when Sherif was talking to her, her son came in to tell her that her grandson and his girlfriend/wife crashed into a telephone pole and weren't wearing seatbelts, and EMS had brought them to this exact same hospital. Needless to say she got upset and sent Sherif out of the room. Man...talk about awful. She was the last patient of the day and I got to go home at 7:30 pm, but...have to be back at the hospital at 5:00 pm to round on my pts. Argh...