Nov 4, 2020
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I guess someone told all of my patients that tonight was my last shift for this rotation because I swear every other name in the ED is someone I saw this month. It's the tour de PDTN.
24 hour call
This won't be the longest I've been awake, but it'll be the longest I've been at work. Relatively uneventful, honestly. Students get called for rapids, codes, admits, and whatever stuff they want to follow up on with their day shift patients. The seniors take it easy on the students. My last three patients are some of the most perplexing cases I've ever had: 55 yo F with relapsing/remitting progressive catatonia-like state, 60 yo M with PMH multiple strokes with increasingly intractable nausea/vomiting for the past four years, 65 yo F with atraumatic subacute low back pain, fevers, chills, right foot neuropathy, right hand dysarthria for the past two months with new onset incontinence but negative lumbar MRI. I kind of like this shift. No rounding = almost no deadline to work shit up and write notes. And time flies on the emergent calls. Then I get to be post-call and enter a deep coma.
Impossible pet project of the week: finding affordable Dulera for a patient with Blue Cross PPO The patient has only been successful at managing their severe asthma on that and Xolera. They've been intubated six times and there's a real worry that they'll die if we don't find a solution. halp
Hello? Uh, is this Poland? Yes, this is Ryan, from America. I mean, uh, this is Dr. A
Intern, trying to contact the US embassy in Warsaw about an emergency visa for a patient's daughter
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the big IM, day 6 week 2
When I left work on Friday, it was 1400 and we had one patient on the list.
When I got back this morning, we had twelve. I guess in the grand scheme of things that still isn’t a lot--the other inpatient service has a list triple that size. Still, I was a little worried but everything went fine. No codes, no rapids, no shitting on my presentations, and got some pimp questions right. Feel like I finally connected to the rotation and my resident team, just in time for their switch day tomorrow lol
We discharged my favorite COPD exacerbation lady today. I’d been seeing her from my first day on the service, and every day I’d sit down and talk with her for a good 30-45 minutes. I really feel I’d gotten to know her, and she had such a big sense of humor.
So when my attending convinced her that discharge was in her favor (she wanted to stay another day but we treated and stabilized all of her acute issues), I went up at the end of my shift to bid her farewell and to explain that going home meant she’d finally get a full night of sleep without people coming in to poke and interrogate her every morning.
She gave me two big hugs and said “you’re gonna be one helluva doctor.”
It was a pleasure meeting you, Ms. R.
the big IM, day 5 week 1
Day 5: Got to take my sweet ass time with my patients since we had such a small list, but I still kept it efficient in terms of charting and data collecting. I checked my clock and let myself hang out with this hilarious lady who came in with a COPD exacerbation for an extra 20 minutes. Having that extra time with my patients makes me think I should reconsider going to a program with a small bed count... it's one of the other big reasons I love my job. I'm off this weekend but I might still go in to round on her (and my other patient if he's not discharged--actually he's pretty funny too. Reminds me of Foghorn Leghorn. Foghorn Infected Leghorn.)
the big IM, day 2 week 1
Day 2: ran out to help ICU with a code. this isn’t truly my story but I’ll share what I know because I was along for the ride.
As we started ACLS, an ICU nurse was trying to get family on the phone. When she finally made contact with the wife, she just kind of goes “Oh, I was wondering where he went. *laughs* I rolled over this morning and he was gone!”
Meanwhile we’re crushing the man’s chest cavity and dumping every medication in the protocol into his blood stream. The nurse tried to impart the severity of the patient’s condition to her, and told her she needed to come right away. The wife shakes it off and says “You know, maybe I’ll come later, I just can’t get a ride right now!”
The nurse, bless her, decides to hop in her car and go pick up the patient’s wife at her house. There’s an ashtray on the porch, and she’s praying she doesn’t get invited inside. Wife opens the door and immediately says “well come on in!” and bumbles around trying to collect her things. She even spends 5 minutes calling out for their dog, who eventually comes out of the basement.
By this point we’re talking about when to stop ACLS. It’s been 25 minutes. The patient went into Vfib, PEA, Vfib, VT, with ROSC for a good 30 seconds in between.
They finally get on their way.
I’m gloved up about to tap in for a round of compressions.
After some discussion, the resident calls time. I’m sent away to make room, gloves off.
The nurse stopped by during PM rounds and told us what happened after. As it turns out, both husband and wife had moderate dementia, which is why the severity of the situation failed to click with her.
Right through the moment she approached his bedside, continually trying to wake him up without concern.
It was the saddest gotdamn thing I’ve heard all week. It’s also one of the reasons I love what I do.
Maybe this is the rare occasion where it’s good she has dementia. Maybe she won’t have to process her husband’s death.