IM: Tuesday Day Call

My last day call was on a Saturday (hospital was half empty), so there was a lot more to do this time around. My mastoiditis patient was doing well, but he couldn't go home this afternoon b/c his culture came back positive for Staph epi that was resistant to everything but vancomycin, chloramphenicol, and gentamycin. He'd been on vanc since his arrival and was doing well on that, but vancomycin has to be administered IV, so we have to keep him here at least one more day. My end stage COPD patient has not had a bowel movement in 4-5 days, despite getting Fleet enemas, mag citrate, and other stool softeners, and Dr. B said, "If she doesn't have a BM by tomorrow, someone needs to disimpact her." Chris said, "That sounds like an MS3 job!" Gee, thanks a lot, Chris. As it turned out, she still hadn't had a BM by the time my shift ended, and both Chris and Alex (the chief resident) were gleeful at the prospect of me having to disimpact her. *sigh* It'd probably be too much to hope for her to have a BM during the night.

I saw two patients today with Chris: an elderly lady with COPD exacerbation (along with multiple other health problems like CAD, CHF, A-fib). Her daughters were with her and one of them has power of attorney; she said her mom was DNR/DNI in case something happens (which I hope not). The second patient was a Vietnamese man with cirrhosis who had new-onset ascites and LE swelling. Because most Asians tend to look yellow, I didn't even realize how jaundiced he was until I looked at his eyes (I'm really not trying to be funny here). Both he and his daughter spoke predominately Vietnamese, so Chris had to get an interpreter on the phone and attach another receiver so that he and the daughter could speak with the interpreter at the same time. After seeing that patient, I followed Chris around to write discharge summaries (only to realize later that the patients couldn't go home for some reason or another; one lady couldn't go home b/c her daughter "wasn't ready to take her in"). We also heard a "Code Verte" (at least that's what it sounded like), which is like a Code Blue for outpatients, in another pavilion, but by the time we got there the pt was stabilized and getting ready for transfer to the ER. Apparently he'd passed out in the middle of an ophthalmology exam, possibly secondary to hypoglycemia.

Patel got an unconscious patient while Chris and I were away, but later her condition got worse and she required intubation. We saw her head CT and it showed something in her brain along with hydrocephalus, weren't sure if it was a mass or a bleed. Annie and I switched off at 7:00 pm, but since I had four coupons to use I got dinner at the cafeteria with Annie and Alex before taking everything up to the lounge. Patel thought I was nuts for staying at the hospital longer than I had to (even if it was for free food), but Alex, Annie, Chris, and I just sat around chatting while watching a basketball game. It was nice to just hang out outside of the ER.

Tomorrow...got to wake up at 4 something again. *sigh*