IM: Bouncebacks

Annie and I got the weekend off, so we arrived at the hospital at 6:30 a.m. to learn that our team had capped yesterday for call. O.O Among our patients were two bouncebacks I'd seen in previous weeks. One was a lady who got a TIPS procedure done last week was back for altered mental status secondary to ammonia buildup (apparently very common after TIPS since blood bypasses the liver and ammonia isn't filtered anymore). Last week she'd been smiling and happy (she works as a translator at the hospital), but today she was huddled under the covers, barely rousable. Her husband said that there were several times during the night where she tried to climb out of bed and had to be put in restraints =/ The other bounceback was my DM II patient who had a resistant form of mastoiditis that he was getting vancomycin for, but a day or two ago he developed a 102 degree fever and, after some googling on vancomycin, deduced that he had "red man syndrome." Don't you just love it when patients try to diagnose themselves? =P Another culture was run and he was found to be sensitive to clindamycin, so he'll be put on that once he leaves the hospital. He was, however, annoyed when he was put under contact isolation (protocol for patients who were recently hospitalized), and it took a while for Dr. B to explain to him that he was under isolation for the protection of other patients, not because he himself was "diseased" (which offended him the most). He was also mad when he was asked to take an HIV test (I saw his partner last week), but it was negative. At any rate, I'll be checking on him and my Vietnamese patient with liver failure tomorrow. Patel tried to assign patients with "educational value" to Annie and me, but as it happened, there weren't many of those. Most of our patients came for chest pain, SOB, and seizures, which we've seen previously.

One of our patients was a "trauma" patient who was found passed out on the street with a blood alcohol concentration of about 55%. It fell down to 29% by the time we saw him, and though Malina said that he was the most alert he's ever been when we rounded on him, he was still pretty out of it. "Are we going to discharge him?" someone asked. Dr. B said no; we'll wait until he's sober, then him some librium. Another patient asked us when he could smoke, and Patel said, "When you go home, you can smoke as many as you want." We couldn't believe said that, but Patel said that there's no point in telling patients they can't do something they're going to do anyway, so it's okay to encourage it. Hmm, if you say so.