ICU: Switcharound

I was prepared to take call today (took the day off yesterday in anticipation of working through the weekend), but then Garrett asked me if I wanted to take call on Monday instead so that I could work with Eddy and he could work with Aaron for the next two weeks. That meant there would be no students working with Aaron today. When I told Aaron what was going on, he just shrugged and said, "Do whatever you want to." I couldn't tell if he was annoyed or flat out didn't care, but it's most likely the latter. In a way, Garrett and I are both relieved to be switching residents. Aaron, being a third year, knows his stuff and has no problems doing procedures by himself, but he's hard to read and sometimes gives the impression that you're insignificant. Eddy is more friendly, more approachable, but he's still learning and as such, doesn't always have the answers to our questions (he didn't do an IJ central line until today). So the tradeoff seems like a good thing for now. In some respects, this ICU rotation has been a letdown as far as students are involved. There have been times when Dr. ML doesn't wait for Garrett or me to present or ask questions before going to see the patient. Maybe it's the attending, b/c I know Dr. C encourages students to do procedures and Dr. O is always available for questions.

Our local alcoholic-turned-septic patient is now receiving end of life care. He has refused all other treatment and is DNR. I remember how when I first saw him back in May, Jordan had pointed him out and said, "That's a train wreck waiting to happen." It was true. This year, he came to the hospital almost every day for a warm bed to sleep in, but not before getting totally wasted on alcohol. (I've seen him standing in street corners and have to wonder where he got all the money to supply his alcohol) Nurses have shared stories about how he used to unhook his IV, leave the hospital, and then come back 2 hrs later drunk as a skunk. Never mind how when he was drunk, he'd become belligerent and cuss people out, throwing F bombs left and right. Not many people will miss him when he passes, but at least he'll be in a warm bed and not out on the streets. The daughter and husband off another of our patients who had a stroke and is now in a coma got "the talk" from Dr. ML, saying they could take her off life support or else do a trach and PEG to make her more comfortable. The husband kept asking why they couldn't just keep her on the vent if she was stable, and he couldn't quite understand when Dr. ML said the trach would only cause more problems if left in the throat beyond 10 days. Dr. ML was careful to address mainly the daughter, who has the medical power of attorney, to keep her informed in case her father tried to convince her to do something she didn't agree with. We'll see what happens then.