IM: Getting feedback

This morning Nanette had the day off, so I went to see her three patients for her. We were hoping that one of our patients, a guy who had confusion and DTs after a vodka-drinking binge, would be able to go home today, but after talking to the night nurse and finding that he needed 2 and 4 mgs of Ativan to calm him down (he tried to climb over the railings of his bed), it was out of the question. On top of that, he can only eat if nurses feed him and his urine output really sucked; his banana bag was nowhere in sight. My stroke patient got his CT and MRI done yesterday; the CT showed no new bleeding, but the infarct has taken up a good 1/3 of his right hemisphere. It's amazing that the only symptoms he has are left hand weakness and left sided numbness. He's also a Vietnam vet, so with his VA connections he should be able to go to a good rehab center once he's discharged. I was supposed to see one other patient, an OB patient with HTN, but Jordan caught up with me and said he'd go see her instead. Funnily enough, he forgot which patients he was supposed to see, so he ended up seeing about 6-7 while Ryan only saw 3.

Rounds progressed as usual (though Jordan lamented that we were picking up more and more "rocks"), and afterwards Dr. L sat down with Angela and me to go over our H&Ps. Angela went first b/c Dr. L never went over her first round of H&Ps (but I told her what went on during my session), so there was a noticeable difference between her H&Ps from last Monday and her H&Ps from Saturday. "This is what I want to see," he said about one of her later H&Ps. When my turn came, he said that for my Wellbutrin overdose lady, I should have mentioned the adverse side effects of too much Wellbutrin and what I should look out for. For my stroke patient, I did a good neuro exam but needed a better plan. My H&P on my liver patient got the best assessment (all thanks to Jordan listing all the things we had to do to work him up), but I failed to mention the prognosis of Budd Chiari (bad). Overall, Dr. L said that we were progressing well, as he expected. We're on call again on Thursday, so my next notes should be even better...I hope.