IM Sub-I: Patients who Nag

The morning proceeded as usual, and of our twelve patients, nine of them were ready for discharge either today or tomorrow. Eager to make our patient list as small as possible, An and I immediately got to work helping Zack print out MOTPs (medicine discharge reconciliation forms; I don't know why they're called MOTPs) and filling out discharge forms for our patients. After lunch, Greg asked me if I had to go to lecture b/c today was Short Call B and we'd be admitting four patients in the afternoon. "I'd rather not," I said, and he told me to ask Ellen (one of the chief residents) to be sure. Fortunately Ellen said fourth years weren't required to attend lecture, so I went to Crash (the triage/urgent part of the ER) and immediately got my first patient: a diabetic man in his 50s with a BKA (below-the-knee amputation) who was sent to the ER by his home health nurse for an elevated creatinine. He felt fine aside from a non-healing ulcer on his left foot (which he will most likely lose before the year is out) and didn't understand why he had to be admitted. Greg gave me a lot of time to think about this case (he saw An's and Zack's patients first), so by the time he got around to me I'd written out my H&P and filled out most of the orders. And this time, I did not dwell on the "non-important" stuff and got straight to the root of the problem, i.e. the patient has acute renal insufficiency and other cormorbidities. While we were down in Crash, we kept getting pages from nurses regarding our floor patients. A 20-year-old who was recently diagnosed with MS kept asking for some Norco for back pain (she'd had a lumbar puncture done), and though Zack said no b/c Norco was too strong for that sort of pain, she was so persistent that he decided to write her a prescription for about 5 to 10 tablets. "Her life's going to be shit from now on," Greg commented, which was another way of saying that in the long run, a stronger pain pill was a small thing to ask for. We also got a page regarding my cirrhosis patient who came to us on Sunday with a fever but now feels well enough to go home; he wanted to know when he could leave. The only thing keeping him in the hospital was an MRCP report (to rule out bile duct obstruction), but the dictation wasn't in the computer or the telephone dictation system. Greg told Zack to check in with radiology and see if they have a dictation or not. "They might get pissed at you for nagging them, but hey, it's part of residency," said Greg. But before Zack could visit radiology, he had to present his patient first. I then remembered how back in Methodist, Dr. M had encouraged Annie and me to check in with pathology any time we wanted b/c the people there love med students and are willing to help us out. Maybe the radiologists here would be more receptive if a medical student (instead of an intern) asks about a report. Deciding to take action, I went to the radiology department, went to the dark room, and introduced myself to one of the radiologists there, explaining the situation and asking if he could help me out. Luckily he was very friendly and pulled up the MRCP right then and there, saying that there was a dictation report in the computer that probably hadn't been uploaded to the system yet. I did notice an accession number beside the dictation, so I copied the number down and thanked the radiologist for his help. I felt like I'd done a good deed when I gave Zack the accession number, but when he punched in the numbers on the phone and put the dictation on speaker phone, we were dismayed to learn that the study had been poor b/c of motion artifact and nothing could be concluded from it. *sigh* The intern on GI immediately called her attending to see if they wanted to repeat the MRCP or just discharge him today; I hope they discharge him, because I was the one who admitted him and I know he's ready to leave. Greg made no mention of my going to radiology, but Zack later thanked me for helping him out. At least I saved him a trip =P This evening I drove to campus and walked to Momoko's for some $4.00 pearl milk tea (but it's worth it). I have the day off tomorrow, and I plan to spend it doing stuff I normally don't do, i.e. going to Zilker Park, going swimming at Deep Eddy, paying a visit to Mozarts, etc.