IM: Lessons Learned

Both Angela and Jordan got the day off today, so it was just me, the two interns, and Dr. L on rounds. My cellulitis patient asked me where I was yesterday, and I told her I'd be seeing her for as long as she was here. I spoke too soon; Dr. L said she'll be transferred to SNF and after that we won't have to see her anymore. I think I may swing by her room on a regular basis anyway, just to see how she's doing and whether or not her cellulitis is healing. The hospital's a lonely place and I haven't seen her parents visit her yet, so maybe she could use a hello now and then.

The biggest issue of the day was our 82-year-old psych patient who was admitted to the hospital screaming, spitting, and biting but now lies curled up in her bed moaning everyday w/o eating or drinking. She's been widowed for 9 years and her only family is a niece who lives in Oklahoma who said the patient had previous signed a DNI/DNR/no feeding tube order. Now, with her not eating, it seems as though she's lost the will to live. Dr. L called the niece today to discuss their options, but thinks that the patient should be placed in hospice care because this is prolonging her suffering. She did open her mouth today to take some oatmeal, so I'm hoping she'll be able to eat a little more to sustain herself until she can transfer to a nursing home or hospice in OK.

We only had five patients on our service (not bad since we're on call tomorrow), and in the 30 minutes before morning report, Dr. L sat down with me to go over my H&Ps. Overall, he said I did a good job with history taking, but wants me to go more in depth into my assessment and plans. For my angina patient from last call, he made me go through a long differential for chest pain and said I should be thinking about all these things when considering chest pain. Dr. L went through every H&P and every progress note with detail and a dark pen, and I was very grateful for his input. This sort of feedback is something I never got at Methodist, and it was a nice change.