IM: Learning More

Normally I set aside 20-30 minutes per patient to write my notes, but for patients with complicated illnesses (i.e. my morbidly obese patient who has a ton of health problems like diabetes, yeast infection, cellulitis, and drainage s/p open appendectomy, to name a few), it can take much longer. I was supposed to see 3 patients by 8:30 and only saw two by 8:10. Fortunately for me, my third patient was taken to the cath lab in the morning so we didn't see her. This patient presented with SOB and chest pain, and we all thought she had something cardiac going on. As it turned out, her cath and echo were completely normal, but her lungs looked really bad. Ryan, one of the interns, wrote the diagnosis as "UIP." Dr. L asked us what we thought UIP was, and I said, "Something interstitial pneumonitis?" Correct, with U = usual. ("As opposed to unusual," said Dr. L). Later I had to put a physical therapy order form in the chart, and the nurse was confused. "You're sending her to PT after a cath?" she asked. I explained that her heart was fine, and that it was her lungs that were bad, and the nurse said, "Oh, we were trying to figure out what this meant" and showed me "UIP." When I told her what it stood for, she laughed and said, "That's not a real diagnosis!" I couldn't agree more =P

Imagine my dismay when I went to the SSU to find the same drunk patient who'd cussed me and my intern out sitting in the same bed having breakfast, but this time he was also wearing an old jacket. One of the nurses went over to him and scolded him for showing up drunk (again) and cussing at other people until the alcohol wore off. He didn't care; he gets a free meal out of it. *sigh* Jordan (the 3rd year resident) said, "That's what it's like to hit rock bottom," referring to that man. Something tells me I'll be seeing a lot of him this month. Another thing I noticed is that the senior residents here don't think very highly of how our school schedules lectures in the mornings when we could be at the hospital learning things. Like JB (my surgery chief), Jordan thought having lectures in the morning was stupid and said, "I don't know what your school is thinking." He was similarly annoyed when he got a long neuro report from the PCC regarding a patient with MS, and Dr. L chided him on his lack of courtesy/respect since students and residents at JPS both come from our school. The neurologist came from our very own Dr. McI, so Angela was told to give him a call. She hesitated after what happened to me yesterday, but Ryan said he didn't see a problem with it. As it turned out, the patient was discharged before the phone call was made, so Angela didn't have to do that consult. Even still, I would hope that since Dr. McI is a professor, he'd be more open to having a student call him for a consult.

Jordan explained how days off work: I'm with Nanette, and Angela is with Ryan. If Ryan's taking the day off, then Angela stays to see his patients, and I take the day off. If Nanette is off, I see her patients, and Angela gets the day off. Ryan's taking tomorrow off, so I get tomorrow off, too. Not that it matters since I still have lecture at school...oh well. I'll take whatever I can get.