So, one of the great things about ID is that you can cure people. Not always, not with HIV or Hepatitis C, but for most, run-of-the-mill infections, you can cure people.
Not so last week.
We had a fantastic lady with a raging pancreatitis. The worst I had ever seen. We see a lot of pancreatitis, and most people do fine. In fact, we get kind of cavalier about it. "Oh, it's just pancreatitis." Not this time.
Our poor lady got super sick, then seemed to rebound. Then, a turn for the worse. But, she popped back! - not quite as good as the peak before, but she looked ok. Then, she tumbled again, farther down than before. A little blip back up, but then down down down.
We kept searching for abscesses, more infections, etc. We had her on excellent coverage for the bacteria we knew about; the rest was up to her body to make a come back.
It wasn't meant to be.
Her family decided that she'd had fought enough, and they elected to make her comfort care only. So, the ICU team made her comfortable, and she died not long after she was extubated.
We were really pulling for her, so our team took it pretty hard. She was such a nice, nice lady, too. I'll miss seeing her everyday.
Wednesday, August 20, 2008
Saturday, August 9, 2008
Square One
So, fellowship is grand. I enjoy specializing and learning about just infectious diseases. I even (usually) enjoy getting a call for a new consult, because it's a new case and something to learn from.
With this new position comes a big piece of humble pie. I don't know anything. Well, I know some things, but I get a lot of calls that require me to call the person back after spending time looking up the answer...and then frustratingly having to call the attending just to make sure I've got it right.
It's a rough transition -- from attending to "intern" again. It's not the workload, which I don't mind and am very used to. It's the impotence I feel when someone asks me a question about MY specialty, and I have absolutely no idea how to answer it.
Last night the ER called me about a patient who had just returned from an African vacation with a few weeks of fever, nausea and vomiting. They wanted to make sure that if the malaria smear was negative, was it ok to discharge her from the ER with follow-up. Well, I'll be darned if I know! So, after checking the CDC website and finding nothing terribly useful about fevers post-Africa, I had to call my attending. Did I mention it was midnight? Yeah, embarrassing. She was terrific, and we talked things through (no, there's nothing else to work-up acutely in the ER). But, I still felt bad calling her.
So, I'm hoping with time I'll pick up a thing or two and be able to handle some of these questions on my own.
With this new position comes a big piece of humble pie. I don't know anything. Well, I know some things, but I get a lot of calls that require me to call the person back after spending time looking up the answer...and then frustratingly having to call the attending just to make sure I've got it right.
It's a rough transition -- from attending to "intern" again. It's not the workload, which I don't mind and am very used to. It's the impotence I feel when someone asks me a question about MY specialty, and I have absolutely no idea how to answer it.
Last night the ER called me about a patient who had just returned from an African vacation with a few weeks of fever, nausea and vomiting. They wanted to make sure that if the malaria smear was negative, was it ok to discharge her from the ER with follow-up. Well, I'll be darned if I know! So, after checking the CDC website and finding nothing terribly useful about fevers post-Africa, I had to call my attending. Did I mention it was midnight? Yeah, embarrassing. She was terrific, and we talked things through (no, there's nothing else to work-up acutely in the ER). But, I still felt bad calling her.
So, I'm hoping with time I'll pick up a thing or two and be able to handle some of these questions on my own.
Monday, July 28, 2008
Ball O' Stress
So, fellowship has been busy for sure!
I've been at work most days from 7:30a-6p, if not later. It's a lot of work, and it's pretty much nonstop. But, I'm enjoying it immensely.
However, it caused me to miss a dear friend's bachelorette party in Vegas. I had booked my flight, arranged a hotel room, etc. Then, I got so overwhelmed that my back went out. I think it's from both a white coat with too many things in the pockets as well as poor posture while reading a million pages of ID material. I'm working on both now.
Nonetheless, I had to tell my good friend, "So sorry, I think I may have a mini-meltdown if I try to go to Vegas and still do the mountains of work I have left to do." It wasn't pretty, and I felt awful for it.
Another casualty of fellowship. Fortunately, the good friend is actually an awesome friend and didn't make me feel worse than I already did. I owe her a bachelorette drink before her wedding. Some quality time with her and the rest of the girls will do wonders for my current mood.
I've been at work most days from 7:30a-6p, if not later. It's a lot of work, and it's pretty much nonstop. But, I'm enjoying it immensely.
However, it caused me to miss a dear friend's bachelorette party in Vegas. I had booked my flight, arranged a hotel room, etc. Then, I got so overwhelmed that my back went out. I think it's from both a white coat with too many things in the pockets as well as poor posture while reading a million pages of ID material. I'm working on both now.
Nonetheless, I had to tell my good friend, "So sorry, I think I may have a mini-meltdown if I try to go to Vegas and still do the mountains of work I have left to do." It wasn't pretty, and I felt awful for it.
Another casualty of fellowship. Fortunately, the good friend is actually an awesome friend and didn't make me feel worse than I already did. I owe her a bachelorette drink before her wedding. Some quality time with her and the rest of the girls will do wonders for my current mood.
Sunday, July 6, 2008
Last Word
I was moonlighting last night, and I got a call from one of the nurses to pronounce a patient at 6:30 this morning. Doctors don't have to be the one to pronounce patients as dead, but nurses for some reason think we have the ultimate power.
Or perhaps it makes them uneasy.
So, I got out of bed and walked up the stairs. I went into the room where the patient -- an elderly woman who had survived 10 years after a liver transplant (no small feat) -- lie dead in her bed.
There's an eerie sort of air in the room of a dead patient. I don't know how to explain it. Perhaps it's because you know going in that the person is dead. Maybe it's the void of life you can sense. Whatever it is, it's unmistakable.
I went through the formalities of listening to her heart ("absent heart tones") and her lungs ("no breath sounds"). I also checked for corneal reflexes ("corneal reflexes absent"). I then called her primary doctor to tell him the not-so-surprising news. The patient was DNAR -- Do Not Attempt Resuscitation. That means no heroic measures, no intubation, no chest compressions and cracking of ribs.
The primary physician said he would call the family, since he had a relationship with them. I wrote my note in the chart and went back to bed. My note will be the last written word in her medical history. "The patient was pronounced dead at 6:30a on 7/6/08." No hoopla. No fanfare. Just a simple testament to the ultimate change in condition. I hope to leave this world as peacefully.
Or perhaps it makes them uneasy.
So, I got out of bed and walked up the stairs. I went into the room where the patient -- an elderly woman who had survived 10 years after a liver transplant (no small feat) -- lie dead in her bed.
There's an eerie sort of air in the room of a dead patient. I don't know how to explain it. Perhaps it's because you know going in that the person is dead. Maybe it's the void of life you can sense. Whatever it is, it's unmistakable.
I went through the formalities of listening to her heart ("absent heart tones") and her lungs ("no breath sounds"). I also checked for corneal reflexes ("corneal reflexes absent"). I then called her primary doctor to tell him the not-so-surprising news. The patient was DNAR -- Do Not Attempt Resuscitation. That means no heroic measures, no intubation, no chest compressions and cracking of ribs.
The primary physician said he would call the family, since he had a relationship with them. I wrote my note in the chart and went back to bed. My note will be the last written word in her medical history. "The patient was pronounced dead at 6:30a on 7/6/08." No hoopla. No fanfare. Just a simple testament to the ultimate change in condition. I hope to leave this world as peacefully.
Saturday, July 5, 2008
Big Bad Fellow
That's how two of my friends have, individually, referred to me in recent days. One is a fellow herself. The other soon will be. It's a different sort of feeling, mostly because you realize that people see you as a "specialist" and you have no idea what you're doing.
Thank goodness for Attendings.
So, I had two days of orientation, harmless enough. Oh, except that I got lost traveling up to a hospital affectionately known as The View. I took another expressway up there, and it threw me off. So, here I am, a big bad fellow, about to cry because I've just passed my exit, I'm about to be late to orientation, and I have no idea when the next turn around is going to come. Rest easy, it all turned out OK.
Then, I had a day of on-the-job training. The old fellow, and residency classmate of mine, helped me learn the ropes. He's rounding this week, then I officially take the reigns on Monday. He'll be there Monday to make sure I don't make a complete debacle out of things, and then the job is mine.
Let the games begin.
Thank goodness for Attendings.
So, I had two days of orientation, harmless enough. Oh, except that I got lost traveling up to a hospital affectionately known as The View. I took another expressway up there, and it threw me off. So, here I am, a big bad fellow, about to cry because I've just passed my exit, I'm about to be late to orientation, and I have no idea when the next turn around is going to come. Rest easy, it all turned out OK.
Then, I had a day of on-the-job training. The old fellow, and residency classmate of mine, helped me learn the ropes. He's rounding this week, then I officially take the reigns on Monday. He'll be there Monday to make sure I don't make a complete debacle out of things, and then the job is mine.
Let the games begin.
Saturday, June 21, 2008
Seeing Your Parents
Perhaps because so many people my age are having babies, I've been thinking about the other side of things: Parents. My Sister, for example, is a great mom. However, I know her simply as my Sister. I know her as the little girl who put orange slices in her mouth and smiled broadly, revealing her big orange peel grin. I know her as the girl who would run through the sprinkler and do hoola hoop gyrations in the front lawn. To me, she's the girl who would listen in on my phone conversations with RW in 7th grade.
So, I extrapolated to my own parents. My Mom was once a little girl who probably played dress up with her cousins. My Dad was once a teenager who could have gotten into scuffles at the school yard. It's hard to look at your parents as people...and not as Parents. Is it possible to see your parents as people?? Or will we always look at them through the lens of a child's eye?
I wonder if my Mom was scared when she went on her first date. Was my dad a heart breaker in grade school, or did he wish the Pretty Girl would say hello at lunch? Did they experiment with drugs? What did they talk about with their best friends? What were their aspirations when they were 12 and 13? What did they say about me and their lives the day I was born? Did they worry about the economy and the Vietnam War? Did my Mom get in trouble for wearing tube tops and hip huggers to school?
As I turned 30, I remembered my own parents turning 30. Well, I remember my Mom turning 30. I was 8. I don't have anyone to parent, so the dichotomy of Parent-Person didn't hit me. Until recently, I always looked at my Folks as Parents -- almost history-less and devoid of an individual personhood. I have had one candid conversation with my Mom a few years back, which helped put my Folks' lives into some historical context. And, hopefully, I will get the chance to know them a little more as people, though I suspect it will be hard to shed the child-colored glasses.
So, I extrapolated to my own parents. My Mom was once a little girl who probably played dress up with her cousins. My Dad was once a teenager who could have gotten into scuffles at the school yard. It's hard to look at your parents as people...and not as Parents. Is it possible to see your parents as people?? Or will we always look at them through the lens of a child's eye?
I wonder if my Mom was scared when she went on her first date. Was my dad a heart breaker in grade school, or did he wish the Pretty Girl would say hello at lunch? Did they experiment with drugs? What did they talk about with their best friends? What were their aspirations when they were 12 and 13? What did they say about me and their lives the day I was born? Did they worry about the economy and the Vietnam War? Did my Mom get in trouble for wearing tube tops and hip huggers to school?
As I turned 30, I remembered my own parents turning 30. Well, I remember my Mom turning 30. I was 8. I don't have anyone to parent, so the dichotomy of Parent-Person didn't hit me. Until recently, I always looked at my Folks as Parents -- almost history-less and devoid of an individual personhood. I have had one candid conversation with my Mom a few years back, which helped put my Folks' lives into some historical context. And, hopefully, I will get the chance to know them a little more as people, though I suspect it will be hard to shed the child-colored glasses.
Thursday, June 5, 2008
Unofficially Over
So, today marks the first day that I'm not chief. Well, I'm technically still chief through the end of the month, but the new chiefs have started, and the transition period has begun. My replacement is fantastic and a quick study. He'll be wonderful.
So, I'm going to start a month of reflection. While that may sound like a lame attempt to procrastinate and delay my reading for fellowship, I think I need some time to decompress. I've been "on" for the last 365 days. I was on pager call everyday -- because even when I wasn't technically on call, people would call me with questions. They never really bothered to look to see which of us was on call. Which was fine. So, today I handed "my" pager over to the new guy. I can't say I was sad to see it go.
So, hopefully, over the next month, I'll have some good things to say about the last year. And, if not "good" at least interesting and character-building. :)
So, I'm going to start a month of reflection. While that may sound like a lame attempt to procrastinate and delay my reading for fellowship, I think I need some time to decompress. I've been "on" for the last 365 days. I was on pager call everyday -- because even when I wasn't technically on call, people would call me with questions. They never really bothered to look to see which of us was on call. Which was fine. So, today I handed "my" pager over to the new guy. I can't say I was sad to see it go.
So, hopefully, over the next month, I'll have some good things to say about the last year. And, if not "good" at least interesting and character-building. :)
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