Sunday, August 23, 2009


I have one patient who is intubated. He's got a tube down his trachea and the machine is breathing for him. We've given him a lot of sedation so it's not uncomfortable. He's sleeping relatively peacefully.

He's been that way for about 3 weeks.

He's 23 and has H1N1, aka swine flu. He's morbidly obese with asthma, two big strikes against him in this H1N1 epidemic.

I'm trying to remain hopeful that he'll survive, but every day it's harder and harder to imagine him recovering. He'll get a tracheostomy this week - a hole in his neck for the tube to go in, rather than passing through his lips and down his throat. His white blood cell count (a marker of infection / inflammation) is still high. He spends most of the day with a fever of 101-102. He's starting to get bed sores, because it's so difficult to turn him adequately due to his size. I'm not sure if he's infected somewhere else, becaues he is too heavy for the CT Scan (weight limit 350lb).

I'm really hoping that by the time I leave the Zoo on 31 August, our big guy will be off the ventilator and on his way to recovery. I can't say I'm all that optomistic, but we will do our best to support him through this.

Monday, August 17, 2009


A big thanks to my sister for giving my page a facelift! I'm not so good at these technical things, so I'm glad that she stepped in took control.

The Zoo is going along as always. We've had some interesting cases. It's been busy, but things have quieted down a bit this past week. I've got a new attending who is awesome. She's the kind of doctor I want to be. She's amazingly smart and articulate. She's also an extreme advocate for her patients. She will do anything for them. She stands up for them, she pushes for the best care possible, and she doesn't care what their background / imigration status / etc. Each patient is a person, and she works hard for him or her.

I'm looking forward to working with Dr. D and learning from her in every way.

Monday, August 10, 2009

Amazing Case

A friend of mine told me a story about a patient he discharged from the hospital about a month ago.

She's a mid-50s-year-old lady, who had an underlying lung disease, something called idiopathic pulmonary fibrosis. That translates roughly to "scarring of the lungs and we don't know why." She developed a heart condition, possibly as a result of the scarred lungs. She also had renal failure - an unrelated, but equally unfortunate, condition. She had been on peritoneal dialysis for awhile - her heart condition meant that she couldn't tolerated traditional hemodialysis three times a week, because the fluid shifts associated with that caused her blood pressure to drop. In hemodialysis, they remove your blood, clean it, and give it back. Not all at once or anything, but a large enough portion is removed that you need to be able to handle the fluid change. So, she did peritoneal dialysis - she would get fluid pumped into the abdomen every night so that it could clean her blood, and then it was removed at every morning.

Well, she recently underwent a heart-lung-kidney transplant. All three (or four, if you count both lungs)! She got all three organs from a 50-ish year old donor, and they are working great. My friend saw her the last 3 weeks in clinic, and she's doing great! Apparently, she's super nice, and she is so grateful for her renewed energy. She can walk around the grocery store now, she can go with her son to Home Depot to get supplies for a home improvement project...she's a new person. Well, with 4 new organs, she really is like a new person!

It's amazing what medicine can do nowadays. Blows my mind.

Monday, August 3, 2009

Back to the Zoo

So, we didn't win the Lotto. Shocker. So, I'm back to work at the Zoo.

Today was a nice 12-hour day. We are battling a swine flu epidemic. We've had quite a few people admitted with H1N1 (the official name for "swine flu") symptoms. Some have turned up positive. Some are negative, but we still think they have it. And some have turned out to have something else. It's been very educational, learning how to deal with an epidemic. There are interesting questions: Who gets prophylaxis? Who gets screened? Who do you still treat even though the screening test is positive? How accurate are the tests? Who should get the vaccine (when it comes out)?

It's not every day an ID fellow gets to be a part of something like this. So, while it is going to make for a very busy month, I'm trying to stay positive and focus on what a great opportunity it is. And while I'll likely watch my summer tan fade without any hope of seeing the sun for awhile, I know I'll end up in a better position when it's all said and done.