I find that in most of my rotations, there's always one or two patients that stick in my mind, and I like to document them so that I won't forget my experience. During my CCU (Coronary Care Unit) rotation, there was Mrs. B.
Basically, Mrs. B. was admitted last week because she had increased swelling of her legs and shortness of breath on exertion; along with other findings, she had classic symptoms of heart failure. It turned out that she also had a heart block and needed a pacemaker so had to be kept in the hospital for that even after she had stabilized. She was probably one of the most grateful patients (who wasn't demented) that I've ever met, and all we had done was given her a diuretic to improve her breathing and help her with her swollen legs (the other medication she needed to be on she was already on or couldn't take because of her heart block)!
It was also great seeing that she was actually interested in making lifestyle changes, as opposed to so many people that you meet that you know won't listen to your advice. She would spend her day reading pamphlets on recommended foods and lifestyle changes to help prevent worsening of her condition. I also found it rewarding because I had the opportunity to explain things to her as well, and it seemed like she understood what I was talking about. She may not have been the most interesting case, but she was definitely my favourite patient while I was on the unit.
Other patients that caught my attention included a 31-year old who came in with florid heart failure (I use the term 'florid' because he had everything - murmurs, extra heart sounds, pulmonary edema, leg edema, and the whole works) likely secondary to chronic alcohol and cocaine use as well as other likely factors. Seeing those patients is kind of sobering, because you know that this could have been prevented solely based on lifestyle choices.
Some of the other cases that I found to be interesting included an elderly man whose pacemaker eroded out of his skin (you could actually see it exposed in his chest wall!) and another man with a myocardial infarction who responded to thrombolytics (a clot-busting medication) - it was just amazing seeing the ECG changes so dramatically within an hour of treatment. I found that with the exception of a few patients, most of the people admitted to CCU really weren't that unstable, so I found it to be quite a good experience since I got a lot of hands-on involvement.
One of my not-so-memorable moments, however, was the last day of my rotation, where I went to the cardiologist's noon hour talk on atrial fibrillation. My preceptor was giving the talk, and he started it off along the lines of, "atrial fibrillation is very common. In FACT, my student just saw a patient in Emerg with this disorder, so I'm going to have him give a brief case presentation about it!" That student, of course, was me. And I had just seen someone with atrial fibrillation. However, I HADN'T expected to present the case in front of the whole audience. So here I am, comfortably seated after having just returned from Emerg and ready to eat the free hot lunch, only to find that I was going to be giving an impromptu talk! Sigh, needless to say, I managed to get through that horror, mainly because I had brought some notes on the patient, but it wasn't my brightest moment.
Anyways, I'm now done CCU and am spending a week in clinics. It'll be a nice break working only half-days this week before I have to go back on the wards to finish off my Internal Med rotation.
Monday, January 21, 2008
Monday, January 14, 2008
That took more time than I'm willing to admit
101 words
I'm sure I could have typed faster but I kept tiring near the end of each minute and making mistakes. Anyways, I'm sure there's a few of you that could beat this, but I'm pleased I managed to finally break triple digits after so many tries. For those of you wondering, I just needed a break away from my reading. :P
**update: new high for me - 103! I think I could go even higher, but I'm going to stop while I still have some semblance of a life
Friday, January 04, 2008
The good and the bad from my internal med rotation
I finished the first part of my internal medicine rotation today at the Royal Alex. It ended up being a lot better than I anticipated, and my only problem with my preceptor was that she tended to round a little too late for my liking. Otherwise, there were good teaching opportunities and many patients to learn from. Some of my better and worst moments are as follows:
I seemed to really have a good experience with my more recent admissions. Mr. G, a nice 82 y.o elderly gentleman, came in for a pneumonia. He had apparently been not coping well at home and got sick. Eventually, he ended up on the floor of his condo and couldn't move for a few hours because he was so weak and tried to drag himself across his floor to the phone, but couldn't. He was eventually found by home care and brought in to the hospital. It was a bit sad, though, because he's also depressed since his wife died, he had his driver's license revoked, and his children wanted him to move out of his condo to get a higher level of care. Essentially, he felt like he was losing a lot of independence in his life. I guess because I spent so much time empathizing with him, he actually told my preceptor that I was one of the best "physicians" he had ever met. That made my day, since I don't get those comments too often!
My other two admissions from my recent call shift, Mrs. W and Mr. M, were equally as pleasant. Mrs. W came in with presumed pneumonia, but then we realized she was in heart failure. Hers was an interesting story because she has an irregular heart beat (atrial fibrillation) and then had unusual abdominal pain on New Year's day, that we later realized was related to her heart failure. She was quite pleasant throughout the whole management, though, and I'm glad I had the opportunity to meet her. Likewise, Mr. M was a pleasant individual and quite agreeable to our management with him. Unfortunately he had quite severe pulmonary emboli (he was coughing up blood and having quite a bit of difficulty breathing), so it's unsure whether or not he'll survive this hospital stay.
Two other patients I quite enjoyed were Mrs. M (my 94 year old patient with cognitive impairment that I talked about in some earlier entries) and another Mrs. M, who came in with a cellulitis and diarrhea. The former Mrs. M was probably my favourite patient during this rotation, as she was normally quite pleasant. I hadn't seen her for over a week because of my winter break, but to my surprise, she recognized me when I returned and actually told me that she had missed me (as you can tell, I've been having a pretty good week)! Because of her cognitive status, she always found a way to amuse me as well. For instance, today, she spent time telling me how she had been having a rough day and had convinced herself that one of her roommates was a prostitute (her roommate, was in fact quite sick, and had probably kept Mrs. M up all night with her moans of distress)! The latter Mrs. M was also quite pleasant, and I always had fun talking with her because she would listen to what I had to say. It's too bad her family is so overprotective of her and that her diarrhea still hadn't resolved even though she's been in hospital for quite a while.
In terms of my not-so-good moments, I particularly remember Mr. G, a cantankerous elderly man who had a previous stroke. He was quite dehydrated and hypernatremic (high sodium in his blood) when I saw him. He was also quite sick, so I don't blame him for being so grouchy. We always had the hardest time understanding him because of his previous stroke, but because I saw him more often than the rest of the team, I began to make out words. Unfortunately, as I began to understand him, I realized that he was telling me to "F* off," and to "get the hell out of here." I was not very pleased, even though I later realized that he was that unpleasant with the nurses as well.
Another day I did not relish was the time one of my Mrs. M's had her heart failure and I had to stay late in hospital because I had to dictate some discharge summaries as well. One thing I never enjoy is having to stay late on a Friday evening when I could be home taking an evening nap. :P
I seemed to really have a good experience with my more recent admissions. Mr. G, a nice 82 y.o elderly gentleman, came in for a pneumonia. He had apparently been not coping well at home and got sick. Eventually, he ended up on the floor of his condo and couldn't move for a few hours because he was so weak and tried to drag himself across his floor to the phone, but couldn't. He was eventually found by home care and brought in to the hospital. It was a bit sad, though, because he's also depressed since his wife died, he had his driver's license revoked, and his children wanted him to move out of his condo to get a higher level of care. Essentially, he felt like he was losing a lot of independence in his life. I guess because I spent so much time empathizing with him, he actually told my preceptor that I was one of the best "physicians" he had ever met. That made my day, since I don't get those comments too often!
My other two admissions from my recent call shift, Mrs. W and Mr. M, were equally as pleasant. Mrs. W came in with presumed pneumonia, but then we realized she was in heart failure. Hers was an interesting story because she has an irregular heart beat (atrial fibrillation) and then had unusual abdominal pain on New Year's day, that we later realized was related to her heart failure. She was quite pleasant throughout the whole management, though, and I'm glad I had the opportunity to meet her. Likewise, Mr. M was a pleasant individual and quite agreeable to our management with him. Unfortunately he had quite severe pulmonary emboli (he was coughing up blood and having quite a bit of difficulty breathing), so it's unsure whether or not he'll survive this hospital stay.
Two other patients I quite enjoyed were Mrs. M (my 94 year old patient with cognitive impairment that I talked about in some earlier entries) and another Mrs. M, who came in with a cellulitis and diarrhea. The former Mrs. M was probably my favourite patient during this rotation, as she was normally quite pleasant. I hadn't seen her for over a week because of my winter break, but to my surprise, she recognized me when I returned and actually told me that she had missed me (as you can tell, I've been having a pretty good week)! Because of her cognitive status, she always found a way to amuse me as well. For instance, today, she spent time telling me how she had been having a rough day and had convinced herself that one of her roommates was a prostitute (her roommate, was in fact quite sick, and had probably kept Mrs. M up all night with her moans of distress)! The latter Mrs. M was also quite pleasant, and I always had fun talking with her because she would listen to what I had to say. It's too bad her family is so overprotective of her and that her diarrhea still hadn't resolved even though she's been in hospital for quite a while.
In terms of my not-so-good moments, I particularly remember Mr. G, a cantankerous elderly man who had a previous stroke. He was quite dehydrated and hypernatremic (high sodium in his blood) when I saw him. He was also quite sick, so I don't blame him for being so grouchy. We always had the hardest time understanding him because of his previous stroke, but because I saw him more often than the rest of the team, I began to make out words. Unfortunately, as I began to understand him, I realized that he was telling me to "F* off," and to "get the hell out of here." I was not very pleased, even though I later realized that he was that unpleasant with the nurses as well.
Another day I did not relish was the time one of my Mrs. M's had her heart failure and I had to stay late in hospital because I had to dictate some discharge summaries as well. One thing I never enjoy is having to stay late on a Friday evening when I could be home taking an evening nap. :P
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