Thursday, August 30, 2007

Quote of the Day, August29th, 2007

Patient is admitted for cardiac/renal problems. She is known to be very non-compliant (had a transplanted kidney from a family member that failed because she wouldn't take her meds), and Dr. S has had this pt before. Patient has a history of seizures. At discharge last time, Dr. S prescribed Dilantin (phenytoin), an anti-seizure medication.

Dr. S: "Are you taking your Dilantin?"
Pt: "No, doctor, because I stopped shaking..."
Dr. S: "Who told you to stop taking your Dilantin?"
Pt: "No one doctor, I just stopped"
Dr. S: "You can't just stop taking your medication...especially ones for seizures"
Pt: "But I'm not shaking anymore, doctor..."
Me (in my head): "Yeah, you're not shaking anymore 'cuz you were taking Dilantin!"
Dr. S: "Are you driving?"
Pt: "Yes."
Dr. S: "AMiB, go grab me a DMV reporting form"

So people out there - if you want to stop taking your meds, no matter what kind, PLEASE, for our safety and yours, ASK your doc before doing so!

Saturday, August 25, 2007

"Code Blue, 6West, Back Hallway"

So last night I was doing an overnight in the ER, and I had my first code of this summer. I've seen 5 or 6 in the past, and participated in 3 or 4, but this is the first one since I started at the hospital this June.

Dr. M (ER doc), the ER tech, and I, all head out of the ER and towards the elevators. We are met there by 2 ICU nurses and 2 Respiratory Therapists. We get up to the 6th floor, and head to the 'back hallway'. As we walk through the nurses station, I'm completely surprised as to how empty it was. They must all be with the Code, I figured. And I was right. As we enter the hallway, I see a scramble of nurses, frantically doing things to save the old man on the floor. I ask for the story, and try and see his face to see if he was one of ours (on the Hospitalist service - he wasn't). He's had had a couple stents placed this morning, and had seemed to be doing fine. He was taking a walk (who goes for a walk at 3.15am?!) with his nurse, when he started to feel faint, brady'd down, and collapsed. No pulse, no respirations - so the Code was called. After a couple rounds of CPR and drugs, we get him onto a bed and into a room. It was then that I realized how many people respond to a code. Roughly 30 nurses, techs, CNAs, 1 doc (which should've been 3 - the ER, the Intesivist, and the patient's Cardiologist), and a handful of Respiratory Techs.
I was standing outside at this point, and couldn't see much of what was going on. I did hear the patient, however: "GET OFF ME! YOU'RE KILLING ME! LET ME GO! LET ME GO!" (we were holding him still while trying to start an IV). These words were masking those of the Respiratory Tech: "Calm down, sir. Your heart stopped and we've had to CPR on you!"

Eventually, he stabilized, and Dr. M went off to talk to the patient's Cardiologist. He didn't feel much like coming in to write orders, and wanted to send his NP to do it. Now, I have nothing against NPs, but if you're a Cardiologist, and you cath'd someone this morning, and they Code: come in. What about the patients family? It's your responsibility to let them know what happened. But anyway, I digress.

By now, he's lost his pulse again. On with the compressions. We secure the airway with endotrachial intubation. The patient kept fluctuating between PEA, Asystole, and Brady, all the way down to the ICU. We get down there and continue compressions. Dr. M puts in a femoral arterial line to see if the compressions are working, as well as if the patient's heart is beating on its own.

At 4.116am, roughly an hour after the Code was called, Dr. M pronounces the patient. The monitor is turned off, and everyone stops what they're doing. We look down at him, and see that his larynx is moving. Either he's trying to breathe on his own, or he's swallowing. Either way, that's not what a dead person does. We feel for pulses: one on each fem, one on each carotid. One of the ICU nurses swears she feels a pulse. Other people feel it as well, so we turn the monitor back on - but they don't match. It's much faster than what is on the monitor. I tell them to feel their own pulse while they're feeling the patients. Yep, those match. I guess it kind of goes to show how much health care professionals want to save their patients. We listen for heart sounds, check reflexes - nothing. His throat was probably just agonal breathing (last breaths).

Time of Death, 4.20am.

Friday, August 24, 2007

Quote of the Day, August 23rd, 2007

So there's this Infections Disease doc, Dr. C. The Hospitalists hate the ID guys, cuz they interfere with our antibiotic treatment and blocking discharges of patients who really should be going home. Anyway, I've NEVER seen Dr. C, but I always see her notes in our charts. For a while, I didn't believe she actually existed. Figment of our imagination, I believed. In reality, she rounds late at night, because her notes are always timed no earlier than 2200 (once, she had put 2430 - because they have to see each patient and write a note each day).

Anyway, today I actually met her. She looks up at me and asks me to question I get so many times -

Dr. C: "So, are you a new Hospitalist?"
Me: "No, I'm just a Medical Student"
Dr. C: "'re awfully big for a medical student"


Saturday, August 18, 2007

15 hours?

So I just spent the past 15 hours in the ER...I think I coulda pulled off the full 18 hours (2 9-hour shifts with 2 different docs), but my parents don't take too kindaly to being gone for 18 hours at a time so I came home...

I really learn alot, and while the doc takes the history, I have started trying to guess their next question (which i'm horrible at) but also what tests they are going to order. I seem to always miss one or two big ones, but hopefully with time I'll get better.

Now please excuse me while I sleep for an unknown length of time.

Friday, August 17, 2007

Oh, how I miss it down here...

So ever since Dr. M (ER doc) gave up his overnight shifts, I've only been able to do 2 shifts a week with him in the ER. For a guy who has a semi-secret desire to be an ER doc, this is not enough. So tonight and [hopefully] tomorrow night, I will be doing some overnight ER shifts with Dr. M (a different one, who happens to be the only lady ER doc that we have). It should be exciting, especially since tomorrow is Friday night, and we're a Level II Trauma Center, meaning we get all the drunk fights and car accidents for 1/4 of our city.

Bring on the energy drinks!


Wednesday, August 15, 2007

An Example of Poor Doctor-Patient Interaction...

Tuesday, August 14, 2007

Quotes of the Day, August 14, 2007

Cardiothoracic Surgeon's NP: "Ugh, I can never get any nurses on that floor to answer their phones!"
Secretary: "What happened?"
NP: "Well this time, I got transferred to another nurse because the nurse I wanted to talk to was stuck in a Code Brown!"
Me: *stupidly looks down at badge, flips through different codes; finds no Code Brown* "What's a Code Brown?"
Dr. A: "Hahaha, you've never heard of a Code Brown?"
Me: "Noo..."
NP: "I'm going to let you figure that one out by yourself."
Me: "ummm....OH!" *face-palm*
NP: "It took you that long? Are you sh*tting me? ;-)"

Monday, August 6, 2007

Quote of the Day, August 6th, 2007

OK, so I went for half a day this morning, but decided to take the rest of today and all of tomorrow off - half for my birthday, half because I've got a bit of pharyngitis going on.

Dr. R - So this patient is on really high doses of prednisone - 100mg daily, and she's been having some hallucinations.
Patient - Yeah, I keep seeing the Pillsbury dough boy...
Me - *tries hardest not to laugh*


AMiB, 19 year old

Happy Birthday to me,
Happy Birthday to me,
Happy Birthday dear AMiB,
Happy Birthday to me!

And of course, like any proper medic would do, I will be spending today at the hospital (with a short interval for gym training).

Have a great day, everyone! :-D

Thursday, August 2, 2007

Pharmacist Respect

Possibly one of the oldest medical spoof videos I've seen...was sent to me by my dad - all you Pharmacists and Pharmacy students out there should appreciate it :-)