Learned a little trick in the ER for when you have 3 year olds whose eyes you need to look into:
Make them watch you do it to their parent, who is holding them. Do exactly what you are about to do to them, then say "OK, now its your turn!" Seemed to work out fine for the 2 young patients we had today (thankfully one did not have the head bleed we were worried about).
-AMiB
So Dr. M had to call a patient today. This is the first time I've seen someone die on the floor (seen 3 or 4 in the ER). Was an 90something year old woman, DNR, had a mid-brain bleed while in a nursing home, was admitted officially for the bleed, but really so that she could die peacefully.
I never realized how much you have to do to pronounce someone. Pupils have to be fixed and dilated, no gag reflex, listen for 1 minute for absent heartbeat, absent Babinski's sign. Then there's the paperwork...don't get me started on that.
It was humbling, to say the least.
There seems to be a lot of secrecy, treachery, vying for power and spying going among amongst some of the Hospitalists. It's kind of funny to me as an outsider, but it'll be interesting to see how this pans out...
I learn so much in 8 hours with Dr. A (medical director), it's kind of ridiculous.
-AMiB
Dr. R: Have you had a bowel movement yet?
Little old lady, diverticulitis who hasn't had a bowel movement in 4 days: No...and they keep giving me stuff, but it doesn't seem like it's working
Dr. R: OK, we'll try some more lactulose...
LOLdwhhabmi4d: Lactulose?! They've given me so much of that, when I finally go it'll blow up the city!!
-------------------------------
At the rounds meeting, discussing one of the Neurologists who likes to call Infectious Disease consults when they aren't really needed:
Dr. R: Yeah, one time she called me because a patient had a scrotal rash
Dr. A: The question is why is a Neurologist looking at his scrotum?!
So, am back form vacation - was fun, but am now back at the hospital...oh well.
-AMiB
Went to a Quality Control meeting today with Dr. A, because he was on call today and is the Medical Director of the Hospitalist service. When discussing 30-day mortality from Pneumonia in our hospital:
QA Guy: "[Our Hospital] has the lowest 30-day mortality rate for Pneumonia in the state!"
Everyone: *claps*
Crit. Care Doc/Pulmonologist/Intensivist: "It's obviously over-diagnosis"
Everyone: *laughs*
Intensivist: "We treat heart failure with antibiotics"
Am leaving for vacation tomorrow, will be back in a week or so (as if I weren't behind enough on my RSS feeds already...)
-AMiB
OK, so I'm gonna try this new thing...it won't be every day, but every time there's something funny...like this :-D
Dr. R: "So, do you take anything for the pain in your leg, like Advil, Tylenol...?"
Little old lady with multiple medical problems (Hx of PE x2, s/p Stents x4, s/p IVC Filter, DVTs, etc): "No, I just take some little stuff...like Vicodin"
Since when did narcotics become so much like candy?! This lady is 83 yrs old, mind you...
-AMiB
For all of you who couldn't make it to see some fireworks this 4th of July, here are some so you don't feel left out:
I'm trying to upload a video of the finale using Blogger Draft's Video feature, but it doesn't seem to be working...oh well.
-AMiB
8am - Arrive at hospital, head to 7W. Dr. B, General Surgeon, is there seeing one of our patients. Funny story about that: We met Thursday when he and Dr. A were discussing the patient. Over the weekend, we went to a party for a family friend. I saw Dr. B, and and for a little while, I didn't recognize him - but then I did. Went over, talked for a bit. Turns out he went to a Uni not too far from mine, and now is practicing General Surgery at my hospital. Says that they'll be writing up the case, and wants to know if I'd like to help out and be published. To which I responded a calm, "Yeah, that'd be great." while inside thinking "HELLZ YEAH!!!". I don't want to get too excited now though, because I always do that and then things never turn out my way.
9am - Start with Dr. S, Hospitalist. Saw a lot of interesting patients. Can't remember any right know though. It's been a long day :-P
11am - Hospitalists Round meeting. As usual
12pm - We're waiting on a drug rep to bring us lunch. All of a sudden this guy from Boston Market comes in.
Boston Market Guy: I'm gonna need a place to put all this food.
Dr. A: Just use this desk.
BMG: Yeah....that's not gonna be big enough....
Dr. A: uhhh...seriously?
BMG: Yeah...well, I'll try.
BMG proceeds to take out large amount of food, including but not limited to: chicken, turkey, steak, corn bread, sweet potato casserole, vegetables, mashed potatoes, gravy, and chocolate chip cookies. It. was. amazing.
BMG then proceeds to tell us about a new use for an old drug, as well as 2 new drugs, which was useful, because we had a patient who needed one. We then scored a free pen and crazy-bright LED flashlight. Should I feel bad for being sucked in by drug reps? Probably. Do I? Absolutely not, lol.
1.45pm - Up on 4E, an amusing conversation:
Nurse (to me): So are you Interning or something? I always see you around with the hospitalists.
Me (to nurse): Nope, I'm just a student. I just follow whoever is on call and watch.
Dr. S: He is a trooper....He's like our groupie.
2.59pm - Finish with Dr. S
3.01pm - Head down to ER. Meet Dr. M, Emergency Physician. Ask to shadow. Start shadowing. I really missed the ER. Had 2 critical patients back to back, both were sedated and intubated using RSI. One was a drug overdose who started vomiting in the ambulance after Narcan administration, went into SVT. When I was leaving, they had tried cardioverting him with no effect. I think they tried some adenosine too, not sure.
8.35pm - Make the decision to leave (that's usually how it is in the ER, because once the new doc comes on, Dr. M stops seeing new patients).
Was quite an educational, eventful, and promising day. And now I am ridiculously tired, I still need to go on the treadmill, and I have to look up everything there is on the internet about SMA syndrome.
-AMiB
Whoo! I am now officially (for the next two years) licensed by the American Heart Association as an Advanced Cardiovascular Life Support Provider.
The class size was really small, so we got out pretty early each day. Was a lot of fun, because it was taught by a firefighter (young guy, been a fire medic for 8yrs), and he was pretty lax about it and made sure we did well and passed.
All in all, was definitely worth it - and now when it comes time to start residency or if I transfer or whatever and need an ACLS cert, all I have to do is the recert class.
-AMiB
