EM: Finale

Wow...these last few days in the ED were definitely memorable, as were the patients. One of them, a guy in his late 30s with a history of DVTs, had a note placed in his chart requesting confidentiality from his own family members, which didn't make much sense to me. When I spoke to him alone, he was really friendly, but when I tried to ask him more questions while his wife and son were in the room, he looked horrified and asked me to come back later. "Everything is confidential, right?" he asked. I didn't understand what he meant until visiting hours were over, and he confessed that his wife was not aware that he was HIV positive (which was written in his chart). Apparently he tested positive soon after they were married (about 5 years ago), and the most likely carrier was a woman he had a relationship with before he met his wife. At any rate, that's why he requests patient confidentiality on all his files, and why he didn't want to talk to me when his wife was in the room: he'd thought I'd ask about his CD4 count and other things. He stated he takes all his HIV meds faithfully and has a undetectable titer. His wife keeps a copy of his medications with him, and I saw that beside the usual HIV drugs it said, "Antiviral medication." I wonder if his wife questions just what kind of virus he has. Maybe she thinks he has hepatitis or something. My attending later commented that his wife can have him arrested and prosecuted for lying about his HIV status, but hopefully it won't come to that anytime soon.

For my last ever ER shift, I had to work from 11 pm to 7 am, and then run up to the 12th floor lounge at 7 am to pick up my patient list and immediately start working on the floors. Thank goodness Dr. PB was willing to let me go at 6:30 am so that I could start on time, and that I was allowed to leave the hospital at noon as though I was post-call. I saw only three patients, and they were all trainwrecks. Two of them had ESRD and their electrolyte levels were outrageous (potassium of 6.8!) The third was a cachetic man dying of terminal lung cancer who was in hospice care, but his wife brought him to the ED after he stopped eating and became less responsive. She was supposed to call hospice before bringing him to the hospital, because hospice patients are discharged from hospice once they're admitted to the hospital. I had to get on the phone with hospice to try to figure out what we could do for this patient, and that took up a huge chunk of my time. Even worse, all three patients had crappy veins, and we couldn't get blood from them without the help of ultrasound-guided line insertions, which could only be done by the third year resident (I knew nothing about using an ultrasound machine). Needless to say I felt useless in the ED and was all too happy to sign out to the ER intern and haul my butt up to the 12th floor, where I once again exchanged scrubs for business casual.

I immediately went to the heme-onc floor (15th floor) to get started on seeing patients. There were currently 5 in the service, not a bad number at all, and I was able to see them all and get notes written on them (with some help from my med students) before the attending arrived. Steve went to morning report but gave me his cell phone number in case I needed help. So far so good. There were three attendings who rotated through our service, two males and one female. The female doctor was in charge of the service; the other two are fresh out of fellowship and therefore more "cool." One of the male attendings came to round with us today and introduced himself to us as "Mickey." Mickey loves to teach, and we spent a good 20 minutes talking about breast cancer and its prognosis based on ER/PR/Her2-neu status. Pretty interesting stuff.

As promised, I got to leave at noon and slept for a good chunk of the afternoon. Hopefully I'll be able to fall asleep tonight.