I don't mean to offend blondes when I say this, since some of the smartest people I know are blondes, but it's a common saying, and it's not intended to be a personal attack on anyone other than myself for being an idiot today.
Usually when I'm post-call, I can function pretty normally, but for some reason, I've been having some not-so-brilliant moments today. It all started with me not assessing a patient for heart failure this morning when he had a known history of heart failure and we had given him fluid yesterday because he looked dry. Thankfully I remembered to check later, but that would have been a very stupid mistake if we had in fact pushed him into a new onset failure.
Then I got home, receiving two separate emails reminding me about my incompetence. Email one informed me that I had returned some music to the university library in the wrong folder (I apparently can't check call numbers), and then email two told me that I had been incorrectly punching in patient numbers in my dictation summaries.
In an attempt to ward off any more of these 'lapses of judgement' I took a nap, only to receive ANOTHER email reminding me of my half day tomorrow. Which I had forgotten to tell my supervisor about. So I had to page him in the evening to tell him that I would not be around tomorrow morning.
Anyways, I'm hoping that that'll be all for today; but just in case, I'm holing myself up in my house and am hoping for a better day tomorrow.
On another note, I found it amusing when I was reading a result for a urine culture last day. The description was more or less as follows: "No growth. Urine sample, however, was found to be partially frozen when brought into the lab, which may have prevented culture growth. In future, please ensure that a fresh sample is used for culturing." It kind of makes you wonder where along the process someone decided to go outside with a sample of urine. I guess maybe the patient was bringing a sample from home, but for some reason, I have a funny image of a technician outside with a urine sample bottle in one hand, and a cigarette in the other.
In Summary:
- I don't seem to be having a good post-call day today, as I almost forgot to do an important aspect of the physical examination on one of my patients, handed in the wrong piece of music to the library, typed in the wrong patient IDs on the dictation system, and then forgot to tell my supervisor that I have an academic half day tomorrow
- On an unrelated aside, I also learned that frozen urine won't culture bacteria :P
Wednesday, February 20, 2008
Wednesday, February 06, 2008
There's always someone interesting to see on call...
Sometimes I find that it's best not to have the 'interesting' patients, as they can be quite the handful. One of the patients who was admitted yesterday to the hospital was quite a bizarre character, but thankfully she wasn't in my care.
This patient came in with a general feeling of unwellness; bad cough, weakness - very nonspecific findings. In fact, she seemed quite healthy, speaking quite comfortably with the resident with the odd comment here and there.
When the standard tests came back, it was quite evident, however, that she was quite sick. She had severe pneumonia in her lungs, her blood pressure was low, and blood cultures came back positive for bacteria (which normally only happens if a person is quite sick). She was started on a standard treatment of antibiotics, and that should have been it with her until she recovered.
However, it turns out that this patient is a drug addict and had problems keeping still (we were wondering if she was withdrawing from something). During the night, she left the hospital against medical advice (AMA) numerous times, only to reappear a few hours later. It was the weirdest thing...one moment, she would be in her bed, and then the next, she would be gone and security would need to be called to find her.
Of course, she wasn't certified, so she was free to leave against medical advice, but it was weird how she would come back and then give us these bizarre stories about why she had left. One time, she told us that she had gone home, cooked some dinner, and then took a shower, and decided it was time to go back to hospital because she was short of breath. The way she told the story was so strange!
And then, later in the evening, the resident was called again because this same patient had been found trying to steal something in the basement of the hospital (in the cafeteria) and had subsequently been arrested. So now, not only did we have a patient who was prone to leaving hospital grounds when she was really too sick to be leaving like that, AND she was also in trouble with the law. The resident was tearing her hair out by the end of our call shift trying to keep track of this one patient. The patient promised that she would no longer leave the hospital, but in case she does, the attending staff provided her with her antibiotics so that she remains to be treated even if she decides to leave once again AMA.
In summary...
- I was on call, and seemingly asymptomatic person came in and was diagnosed with very severe pneumonia
- This same patient became quite a handful during the evening and ended up leaving hospital grounds numerous times against medical advice, only to show up again a few hours later because she was too sick to remain away from hospital
- Eventually, she settled at the hospital, only to be found in the basement trying to steal something from the cafeteria! She was then arrested, but kept in hospital to receive treatment.
- Thankfully, this was not my patient, but the resident spent most of her night trying to deal with this whole fiasco
This patient came in with a general feeling of unwellness; bad cough, weakness - very nonspecific findings. In fact, she seemed quite healthy, speaking quite comfortably with the resident with the odd comment here and there.
When the standard tests came back, it was quite evident, however, that she was quite sick. She had severe pneumonia in her lungs, her blood pressure was low, and blood cultures came back positive for bacteria (which normally only happens if a person is quite sick). She was started on a standard treatment of antibiotics, and that should have been it with her until she recovered.
However, it turns out that this patient is a drug addict and had problems keeping still (we were wondering if she was withdrawing from something). During the night, she left the hospital against medical advice (AMA) numerous times, only to reappear a few hours later. It was the weirdest thing...one moment, she would be in her bed, and then the next, she would be gone and security would need to be called to find her.
Of course, she wasn't certified, so she was free to leave against medical advice, but it was weird how she would come back and then give us these bizarre stories about why she had left. One time, she told us that she had gone home, cooked some dinner, and then took a shower, and decided it was time to go back to hospital because she was short of breath. The way she told the story was so strange!
And then, later in the evening, the resident was called again because this same patient had been found trying to steal something in the basement of the hospital (in the cafeteria) and had subsequently been arrested. So now, not only did we have a patient who was prone to leaving hospital grounds when she was really too sick to be leaving like that, AND she was also in trouble with the law. The resident was tearing her hair out by the end of our call shift trying to keep track of this one patient. The patient promised that she would no longer leave the hospital, but in case she does, the attending staff provided her with her antibiotics so that she remains to be treated even if she decides to leave once again AMA.
In summary...
- I was on call, and seemingly asymptomatic person came in and was diagnosed with very severe pneumonia
- This same patient became quite a handful during the evening and ended up leaving hospital grounds numerous times against medical advice, only to show up again a few hours later because she was too sick to remain away from hospital
- Eventually, she settled at the hospital, only to be found in the basement trying to steal something from the cafeteria! She was then arrested, but kept in hospital to receive treatment.
- Thankfully, this was not my patient, but the resident spent most of her night trying to deal with this whole fiasco
Saturday, February 02, 2008
Worse than a fly on the wall
I guess my posts are getting too long. I write them more for myself so that I won't forget my more memorable experiences on the wards so that I can remember them later when I'm doing interviews. But I can understand how some people can find them too long to sift through...so by popular request (one person, really), I'll start including 'Coles Notes' versions of my experiences at the end of each post. Now onto my real post...
I was on anesthesiology this week, which was a good experience in the sense that I got to practice a lot of IV starts (sadly, I more than doubled my previous number of IV starts, showing how inexperienced I was prior to this) and how to properly bag-mask patients in case an emergency occurs. I may not be able to intubate patients that well, but at the very least, if someone crashes on me, I can now ventilate them properly until someone more competent comes along!
My experience was pretty standard for most of the week, which was expected since the chief resident specifically picks certain rooms for the students to ensure that the teaching is good and the cases aren't too complicated. However, on the Thursday, it just wasn't a good day in terms of which rooms had good cases, so I was put in a room with longer operations, which was when my one 'exciting' experience occurred:
So we were about to send in our last patient of the day for a simple polyp removal when the doctors get paged about a patient (demographics unknown) who had a presumed rejection of a small bowel replacement and a low hemoglobin. These sort of cases get priority over the elective surgeries, so she was rushed into the OR to see what was actually going on with her. Things were going as planned: she was anesthetized, prepped, and then her abdomen was opened up to get a better look at her bowels.
Now because I wasn't doing much except for starting the occasional IV and learning how to ventilate patients, I was in the habit of watching the surgeries from behind the sterile field, standing on a stool. So here I am, watching the surgeon open up the patient, suction up what was presumed to be old blood, when I notice (as does everyone else) that something's not quite right: even though the surgeon was suctioning out the liquid from her abdomen, it wan't emptying! And in fact the liquid had started to appear BRIGHT RED.
At that point, I stepped back from my stool and decided to get out of the way. Which was a good thing, because the anesthesiologist then said "um, gentleman, I'd just like to let you know that this patient no longer has a detectable blood pressure" (as measured from arterial pressures, which is more accurate than the pressure cuffs)...and then things happened in a blur.
Things were not ideal, since there were a lot of student nurses assisting (we hadn't originally planned to do the emergency procedure), so suddenly they were shouting for more help. The anethesiologist asked for some techs to come in as well. They had about 6 units of blood present, so suddenly the techs and the anesthesiologist were literally pushing in the blood as fast as they could as well as bags of other solutions. Meanwhile the surgeon and his resident were madly trying to stop the bleeding.
By the time all of the blood and solutions had been given (quite quickly I may add), the patient was barely stabilized at a decent pressure, and they had already asked for more blood to get sent. The surgeon then decided the only way to stop her bleeding was to cut open her chest and clamp off her aorta, so then he started yelling for a kit for that. One wasn't present. Then he started yelling at the nurses, telling them it was unacceptable that one wasn't readily available.
Anyways, in the end, the appropriate kit was found, the patient's aorta was clamped, and things proceeded more or less smoothly. Unfortunately, the patient's transplant was obviously rejected, so they had to remove that (it was obviously necrotic on appearance), but from my understanding, she ended up in ICU for recovery, so the surgery was a 'success' in that sense.
I'm sure you're all wondering now: what role did I play in all of this? Pretty much nothing. Initially, I tried helping out by giving the anesthesiologist what he needed, but it quickly became apparent to me that my knowledge (or lack of it) was insufficient to be of any use. So I ended up stepping into a corner and tried my best to get out of the way, which is hard since so much of the OR has equipment and there's not much standing room. I have to admit that I've never felt so useless in my life (even the student nurses knew more than I did and could help out a bit), but at the same time, I thought it was really neat seeing what they do. The anesthesiologist was really nice too and showed me some tips on what to do if I ever ran into a situation like that again (although I still think I'd stay out of the way until I developed a few more skills). This is why I think we should get some more practical training in our first two years before we're stuck in the hospital...
So, in summary...
- I spent a week in anesthesiology learning how to improve my IV starts and bag-mask patients
- On the Thursday, a patient's surgery was cancelled for a more urgent one (a possible rejection of a bowel transplant)
- During this surgery, the patient essentially crashed on us because of an active bleed in her abdomen. The surgeon and his team madly tried to stop the bleeding, while the anesthesiologist and his techs madly tried re-infusing the patient with blood and solution to replace this loss.
- Tempers flared when the surgeon decided to open up the patient's chest to clamp off her aorta to help stop the bleeding and the nurses couldn't bring a kit in a timely matter.
- Eventually they were able to stop the patient's bleeding, stabilize her, and remove her rejected bowel implant (not to be mistaken for a stool implant, which is a completely different procedure. Ask me about it if you're curious, but that's something unrelated to the current topic). She ended up in the ICU for recovery.
- I was useless the entire time
I was on anesthesiology this week, which was a good experience in the sense that I got to practice a lot of IV starts (sadly, I more than doubled my previous number of IV starts, showing how inexperienced I was prior to this) and how to properly bag-mask patients in case an emergency occurs. I may not be able to intubate patients that well, but at the very least, if someone crashes on me, I can now ventilate them properly until someone more competent comes along!
My experience was pretty standard for most of the week, which was expected since the chief resident specifically picks certain rooms for the students to ensure that the teaching is good and the cases aren't too complicated. However, on the Thursday, it just wasn't a good day in terms of which rooms had good cases, so I was put in a room with longer operations, which was when my one 'exciting' experience occurred:
So we were about to send in our last patient of the day for a simple polyp removal when the doctors get paged about a patient (demographics unknown) who had a presumed rejection of a small bowel replacement and a low hemoglobin. These sort of cases get priority over the elective surgeries, so she was rushed into the OR to see what was actually going on with her. Things were going as planned: she was anesthetized, prepped, and then her abdomen was opened up to get a better look at her bowels.
Now because I wasn't doing much except for starting the occasional IV and learning how to ventilate patients, I was in the habit of watching the surgeries from behind the sterile field, standing on a stool. So here I am, watching the surgeon open up the patient, suction up what was presumed to be old blood, when I notice (as does everyone else) that something's not quite right: even though the surgeon was suctioning out the liquid from her abdomen, it wan't emptying! And in fact the liquid had started to appear BRIGHT RED.
At that point, I stepped back from my stool and decided to get out of the way. Which was a good thing, because the anesthesiologist then said "um, gentleman, I'd just like to let you know that this patient no longer has a detectable blood pressure" (as measured from arterial pressures, which is more accurate than the pressure cuffs)...and then things happened in a blur.
Things were not ideal, since there were a lot of student nurses assisting (we hadn't originally planned to do the emergency procedure), so suddenly they were shouting for more help. The anethesiologist asked for some techs to come in as well. They had about 6 units of blood present, so suddenly the techs and the anesthesiologist were literally pushing in the blood as fast as they could as well as bags of other solutions. Meanwhile the surgeon and his resident were madly trying to stop the bleeding.
By the time all of the blood and solutions had been given (quite quickly I may add), the patient was barely stabilized at a decent pressure, and they had already asked for more blood to get sent. The surgeon then decided the only way to stop her bleeding was to cut open her chest and clamp off her aorta, so then he started yelling for a kit for that. One wasn't present. Then he started yelling at the nurses, telling them it was unacceptable that one wasn't readily available.
Anyways, in the end, the appropriate kit was found, the patient's aorta was clamped, and things proceeded more or less smoothly. Unfortunately, the patient's transplant was obviously rejected, so they had to remove that (it was obviously necrotic on appearance), but from my understanding, she ended up in ICU for recovery, so the surgery was a 'success' in that sense.
I'm sure you're all wondering now: what role did I play in all of this? Pretty much nothing. Initially, I tried helping out by giving the anesthesiologist what he needed, but it quickly became apparent to me that my knowledge (or lack of it) was insufficient to be of any use. So I ended up stepping into a corner and tried my best to get out of the way, which is hard since so much of the OR has equipment and there's not much standing room. I have to admit that I've never felt so useless in my life (even the student nurses knew more than I did and could help out a bit), but at the same time, I thought it was really neat seeing what they do. The anesthesiologist was really nice too and showed me some tips on what to do if I ever ran into a situation like that again (although I still think I'd stay out of the way until I developed a few more skills). This is why I think we should get some more practical training in our first two years before we're stuck in the hospital...
So, in summary...
- I spent a week in anesthesiology learning how to improve my IV starts and bag-mask patients
- On the Thursday, a patient's surgery was cancelled for a more urgent one (a possible rejection of a bowel transplant)
- During this surgery, the patient essentially crashed on us because of an active bleed in her abdomen. The surgeon and his team madly tried to stop the bleeding, while the anesthesiologist and his techs madly tried re-infusing the patient with blood and solution to replace this loss.
- Tempers flared when the surgeon decided to open up the patient's chest to clamp off her aorta to help stop the bleeding and the nurses couldn't bring a kit in a timely matter.
- Eventually they were able to stop the patient's bleeding, stabilize her, and remove her rejected bowel implant (not to be mistaken for a stool implant, which is a completely different procedure. Ask me about it if you're curious, but that's something unrelated to the current topic). She ended up in the ICU for recovery.
- I was useless the entire time
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