Thursday, June 14, 2007

Week 1, Part 2

8.30am - Arrived on 7W
8.35am - Dr. S arrives on 7W (first time I have arrived before a Hospitalist :-P); Rounding begins. This time, was equipped with my Sanford Guide (2003, need to get a new one), my PIMP Protector, and my sister's Oxford Clinical Handbook. All of which came in useful. We saw quite a number of patients, some of which who were very nice and polite, and others who were, as Dr. S put it, "bitches". I just smiled like a good little medical student :-). Let's see...notable cases: a lady with a new onset of back pain from an old L1 compression fracture, as well as an unkown pain in the mesogastric area of her abdomen. History of shingles (Herpes Zoster), coronary artery disease s/p 3 stents placed about 5 years ago, renolithiasis stuck in renal pelvis (but asymptomatic), an ovarian cyst, and rheumatoid arthritis. Dr. S orders a test for rheumatoid factor, ANA & ESR to see if abd. pain might be rheumatoid in origin; MRI of back to look for any possible new fractures leading to her back pain; MRA of abdomen to look for atherosclerosis of mesenteric arteries, possibly leading to abdominal pain. Was quite the interesting case. Dr. S called her a bitch. :-P
Saw a 90 year old lady with Alzheimer's, who had been prescribed sleeping medication q4hrs PRN. Nurse (at care facility) had given it q4hrs instead, as well as ativan (wtf, why?), and patient sort of just nodded off...for a few days. Was starting to wake up today, A&Ox1(name)
We were called for a consult on a young lady who had had gastric bypass surgery 3.5 years ago, and now is having abdominal pain. Bariatric surgeon went in, lysed some adhesions, but didn't find anything else that could be causing the pain. So called for a Med consult. We (and when I keep saying 'we', I mean Dr. S, with me following like a sheep...or a shadow :-P) figure it's an infected blind loop, and call for a GI consult to do endoscopy so we can biopsy the sac.

Finally asked Dr. A and Dr. S what they do after rounds, while waiting for consults. They say mostly the admits/consults pile up, so they don't really get a break. Usually lunch is their first stop, though.

Am looking forward to working with Dr. C tomorrow (she's the same race as me...always fun lol)

8am - Working with Dr. C today. She only had 5 or so patients, but was on call. I just realized that me describing my day week after week will get boring after a while, so maybe I'll continue, maybe I won't. Saw some diverticulitis patients, lobar pneumonia (possibly community-acquired, possibly aspiration). Had my first (well, first with the Hospitalists) drug rep visit. Some nice ladies from the companies that make Lovenox (enoxaparin, a LMWH - low molecular weight heparin) and Lantus (insuline glargine) came in and brought us lunch (Sanofi Aventis, I believe). Apparently, Lovenox is now approved for STEMI patients. Fancy that. I got a free lunch and a pen and a clickie-sharpie, both with LOVENOX written on them. Awesome.

Got the weekend off (err...will take the weekend off?), and am working with Dr. C again on Monday, 8am.