Last night Aaron had seven new admits, and only got one hour of sleep. If I'd been on call with him, I undoubtedly would have suffered the same fate (though I didn't sleep much better; I only got about 4-5 hrs of sleep b/c I had trouble falling asleep). Needless to say we were all relieved when we found that we'd be rounding with Dr. C (who rounds at lightning speed) instead of Dr. ML. Even still, because we had 15 patients to see, we didn't get done until shortly before noon. My longterm patient finally went to an L-tach yesterday, so I no longer have any established patients (saw two patients for Garrett and Aaron today). I'll have to ask Aaron to for some of his patients tomorrow.
We had two problem patients today: one was a man from IPA with a bad case of A-fib, and another was a septic patient we've had for over a week (coincidentally, he was also in IPA before he coded and had to be brought up to ICU) who, according to Dr. ML, was finally succeeding in dying after trying for many days (more on that later). Aaron was all excited about seeing a possible cardioversion on our A-fib guy ("Mr. Red"), but was so busy making phone calls and other things that he missed it. Mr. Red was sedated, the pads placed on his chest, everyone clear, then BZZT! His eyes flew open and he gasped, but the shocks did the trick; his heart resumed a normal sinus rhythm. We thought that was the worst of it, but suddenly he developed very bad SOB, and even with the oxygen turned on full blast he was still only sating at 80% or worse b/c he kept coughing and gasping. At one point he coughed up some frothy red stuff, and the nurse, afraid that he would need to be intubated, called Dr. C over the intercom. Dr. C hurried over to see what was going on and suggested giving Mr. Red some Ativan to calm him down, then put in a Foley (which he'd originally refused) and some Lasix to treat what was most likely flash pulmonary edema secondary to pneumonia (he had infiltrates on CXR). The Ativan helped a lot, and with the Lasix and Foley he ended up making a lot of urine. Let's hope that'll help with his flash pulmonary edema; of all our patients, we got paged the most regarding his care.
Our other IPA patient was "actively dying," but I still have no idea what that means. His blood pressure held steady in the 70s-80s/50s, and he was completely dependent on the ventilator (his sats were about 70%), but I'd expected "active dying" to be a quick, noticeable decline, the way little AJ's heart rate dropped to zero in a matter of minutes back at Driscoll. I took a closer look at him and saw that there were tears in his eyes. That made me sad. =(
Loan and Heather were on call today, and I ended up hanging out with Loan. She told me that I should take call with her sometime, since she and Heather operate independently of each other. Sounds tempting, but I think I'll stick to working with Eddy for a while. Unless another fourth year comes along, then I may give up my spot (and Garrett will think I'm being too nice again). Speaking of fourth years, apparently Mafruha didn't make a favorable impression on some of the residents last week. Of course, it's hard to live up to Mike and Jay's standards (those two were on top of everything and Jay chatted with Dr. C when he was in the ICU during his medicine rotation). In addition to being on call tomorrow, I'm also meeting with the chairman of IM at our school to get a rec letter. Hopefully I'll make a favorable impression on him.
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Is Dr T from GI the chairman of IM?
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