IM: Mass Patient Discharge

Yesterday we had a full list of 24 patients; this morning we had 14 b/c Chris and Malini managed to discharge 10 yesterday (9 of those were from 4 South so the social worker on that floor was ecstatic). Everyone congratulated the interns on a job well done. Chris was especially relieved to have discharged a few "rocks" including the lady who came in for a COPD exacerbation but ended up staying over a week for chronic constipation, knee pain, and chest pain that might have been psychosomatic. Even at the end, said Chris, she said that she had problems swallowing in an effort to stay at the hospital longer, but he assured her she'd be fine. My mastoiditis patient who had a drug reaction to vancomycin was doing well; he's ready to go home. My liver failure patient, sadly, was not in good shape. The ascites and the LE edema had disappeared over the weekend, but now I could appreciate just how thin and weak he appeared. His daughter was concerned that he wasn't eating well, so we may put him on a feeding tube. He's currently being evaluated for a liver transplant, yet I have to wonder: compared with younger patients, who's going to give a liver to a 67-year-old man? Maybe his children will be a match if they are willing to be living donors. Our TIPS lady was doing better, but was still confused and complained of diarrhea secondary to lactulose, which she'll have to take for the rest of her life in order to keep her ammonia levels down. I questioned if maybe she would have been better off without the TIPS (she was asymptomatic before the TIPS aside from some hematemesis secondary to varices), and Malina said no. Eventually, the patient would have had ascites that required regular paracentesis, and TIPS prevented her from having that. But at the cost of diarrhea for the rest of her life? Maybe she can take something to harden the stool a bit.

Before rounds I met with Chris and Patel in the library. Annie called Chris' cell to see where they were meeting and Chris said, "That was Med Student 2." Pointing to me, he said, "That's Med Student 1." What were we, Thing 1 and Thing 2 from The Cat in the Hat? I also asked for advice on Step 2; Chris recommended USMLEWorld and USMLE2 Secrets. I have an old edition of Crush the Boards that I'll probably use in lieu of Secrets (same author), and I may refer to First Aid and USMLEWorld later on. We'll see. Boards in two months....AAAAAAAAH!!!