Just a short entry today. I'm in the midst of my surgery rotation, and it's been busy. Things are a bit of a blur when it comes to dealing with our patients, and the nurses help us out by writing up a problem list every day. Some of the items they ask for, though, are a little ridiculous.
I was a little annoyed when I was approached by a nurse today who got on my case for crossing out one of the problems she had written down. A patient needed blood transfusions, so the order was written something along the lines of "transfuse 2 units packed red blood cells. Give lasix between units." She apparently had problems understanding that order, but I fail to see what part was hard to understand. She could have even asked another nurse for clarification if she didn't understand what it meant, since it's a pretty standard order.
When it's 2 in the morning and you have a choice between dealing with an important issue or something like the example above, I think you can see where my priorities will lie.
Sunday, April 27, 2008
Saturday, April 12, 2008
Some random cases...
I guess I haven't really blogged about any of the cases I saw while I was doing my nephrology elective in Toronto, so I'll do so now before my next rotation begins. Although people say that kidney failure is better to have than other types of organ failure, it's still not a great thing to have; and after this experience, I really don't think it's something I would wish upon my worst enemy because of the complications that can arise.
Sure, having kidney failure isn't always bad: if found early enough, you can get dialysis set up, and depending on the dialysis, you can lead a fairly normal life. However, after only spending two weeks on the ward and consult service, I've seen how when things go wrong, they can go horribly wrong.
I'm sure you've heard people say that you should only get surgery if you absolutely need it. What happened to one of the patients I saw exemplifies why. Part of the ward experience involved calling in patients awaiting transplant, so on my first day on the wards, one such patient came in. He appeared quite healthy (other than his kidney failure) and was joking around with us before his surgery. He told us that he had come in before for transplant surgery but ended up not receiving it because he had suffered a heart attack on the operating table, just prior to getting the kidney. However, since then, he had been cleared by his cardiologist and was looking forward to this upcoming transplant.
We wished him well and went off for the night, since the transplant was occurring later in the evening. The next day, though, he ended up in the ICU, and not back on our ward. It turns out that post-operatively, he had developed another heart attack and became quite sick. Subsequently, his kidney transplant rejected, and he ended up clotting all the lines that were inserted into him to get dialysis going. By the time I finished my elective, he was still in the ICU, and doctors still had not completely figured out what had happened to him (they suspect, though, that he might be susceptible to clotting, which would explain most of what had happened after the surgery). That was hard to swallow, knowing that the patient had ended up worse off post-op than pre-op.
The next case that sticks in my mind was a 20-year old guy who was involved in a motor vehicle accident. There was multiple trauma, several fractures, and multi-organ failure including the kidney. I ended up taking on this patient when I went on the consult service, and I could not believe how many issues he had. He literally ended up going to the operating room every second day and had so many lines and monitors attached to him. I think the only reason why he was able to tolerate so many operations was because he was so young. Having kidney failure, though, just made things worse, since it caused electrolyte abnormalities and other issues to compound to his already difficult condition. If he manages to get out of this alive, I'm sure he'll be having issues for the rest of his life. Oh, btw, alcohol and probably some other foreign substance was involved. I sometimes hear people complain about law enforcement and drinking and driving, but it's done to prevent incidents like this.
Anyways, it was an interesting rotation, but not exactly something I want to deal with for the rest of my life.
In summary:
- although kidney failure patients can lead a relatively normal life, when complications arise, things can go quite horribly wrong
- one of the patients I saw came in for a transplant, and ended up becoming sicker post-operatively compared to pre-operatively, because he suffered a heart attack on the operating table, rejected his transplant, and ended up clotting all of his lines used for dialysis. He was still in the ICU and was still quite sick by the time I left back to Edmonton.
- another patient I 'managed' (I use that term loosely, because he was much too sick, so the resident and staff looked after him as well) ended up in the ICU because of an alcohol-related motor vehicle accident. He required several surgeries, and I'm sure he's still there with multi-organ failure.
- Seeing how sick these patients can get has ruled out one specialty for me. I can deal with sick patients, hence my interest in oncology, but I guess I have my limits.
Sure, having kidney failure isn't always bad: if found early enough, you can get dialysis set up, and depending on the dialysis, you can lead a fairly normal life. However, after only spending two weeks on the ward and consult service, I've seen how when things go wrong, they can go horribly wrong.
I'm sure you've heard people say that you should only get surgery if you absolutely need it. What happened to one of the patients I saw exemplifies why. Part of the ward experience involved calling in patients awaiting transplant, so on my first day on the wards, one such patient came in. He appeared quite healthy (other than his kidney failure) and was joking around with us before his surgery. He told us that he had come in before for transplant surgery but ended up not receiving it because he had suffered a heart attack on the operating table, just prior to getting the kidney. However, since then, he had been cleared by his cardiologist and was looking forward to this upcoming transplant.
We wished him well and went off for the night, since the transplant was occurring later in the evening. The next day, though, he ended up in the ICU, and not back on our ward. It turns out that post-operatively, he had developed another heart attack and became quite sick. Subsequently, his kidney transplant rejected, and he ended up clotting all the lines that were inserted into him to get dialysis going. By the time I finished my elective, he was still in the ICU, and doctors still had not completely figured out what had happened to him (they suspect, though, that he might be susceptible to clotting, which would explain most of what had happened after the surgery). That was hard to swallow, knowing that the patient had ended up worse off post-op than pre-op.
The next case that sticks in my mind was a 20-year old guy who was involved in a motor vehicle accident. There was multiple trauma, several fractures, and multi-organ failure including the kidney. I ended up taking on this patient when I went on the consult service, and I could not believe how many issues he had. He literally ended up going to the operating room every second day and had so many lines and monitors attached to him. I think the only reason why he was able to tolerate so many operations was because he was so young. Having kidney failure, though, just made things worse, since it caused electrolyte abnormalities and other issues to compound to his already difficult condition. If he manages to get out of this alive, I'm sure he'll be having issues for the rest of his life. Oh, btw, alcohol and probably some other foreign substance was involved. I sometimes hear people complain about law enforcement and drinking and driving, but it's done to prevent incidents like this.
Anyways, it was an interesting rotation, but not exactly something I want to deal with for the rest of my life.
In summary:
- although kidney failure patients can lead a relatively normal life, when complications arise, things can go quite horribly wrong
- one of the patients I saw came in for a transplant, and ended up becoming sicker post-operatively compared to pre-operatively, because he suffered a heart attack on the operating table, rejected his transplant, and ended up clotting all of his lines used for dialysis. He was still in the ICU and was still quite sick by the time I left back to Edmonton.
- another patient I 'managed' (I use that term loosely, because he was much too sick, so the resident and staff looked after him as well) ended up in the ICU because of an alcohol-related motor vehicle accident. He required several surgeries, and I'm sure he's still there with multi-organ failure.
- Seeing how sick these patients can get has ruled out one specialty for me. I can deal with sick patients, hence my interest in oncology, but I guess I have my limits.
Tuesday, April 08, 2008
I need one of these...
http://www.nubrella.com/
Apparently someone's finally invented an umbrella that doesn't require the use of your hands. The model makes the apparatus look quite stylish, but I unfortunately am not one of those individuals who looks good with everything, so I'm sure I'd give it a geeky touch. It's too bad I haven't installed photoshop on my new laptop, otherwise I'd give you an artist's rendition of how I'd look with it (ie. a picture on how not to sell something).
To read a somewhat amusing story about the nubrella, check out the CBC article that I read that first enlightened me about this invention: http://www.cbc.ca/cp/Oddities/080408/K040815AU.html.
Apparently someone's finally invented an umbrella that doesn't require the use of your hands. The model makes the apparatus look quite stylish, but I unfortunately am not one of those individuals who looks good with everything, so I'm sure I'd give it a geeky touch. It's too bad I haven't installed photoshop on my new laptop, otherwise I'd give you an artist's rendition of how I'd look with it (ie. a picture on how not to sell something).
To read a somewhat amusing story about the nubrella, check out the CBC article that I read that first enlightened me about this invention: http://www.cbc.ca/cp/Oddities/080408/K040815AU.html.
Wednesday, April 02, 2008
Say what?
Some of the things my patients tell me just blow me away; it's so hard at times to keep a straight face, because you know they're trying to be helpful, but I can't help thinking to myself, "you did what?" or "say what now?"
That's what happened today, when I was asked to see a consult for a patient with "hematuria" (blood in the urine). In every history, I find that it's a good idea to get a timeline, since it makes things easier to present later on to the staff physician. So, for this case, I asked my standard question, "so, when did you first notice blood in your urine?"
The response: "Oh, two days ago. My mother first noticed it and told me about it." (note: this was a 29 year old lady who is perfectly capable of going to the washroom on her own and did not require assistance from anyone else)
I continued with the history, but in the back of my mind, three things popped up almost simultaneously:
1) You didn't notice the FRANK BLOOD in your own urine?
2) How the heck did your mother get the opportunity to see your urine (and for that matter, why would she look at your urine)?
and if the answer to 2) was that she saw it in the patient's toilet, my third question was
3) Don't you flush?!?
I've learned, though, that some things are best not asking out loud, if you want to maintain the patient-physician trust.
In summary:
- I had a patient who told me she first knew she had blood in her urine because her mother noted this issue
- This was a grown, independent, patient, which makes you wonder how the heck she missed the red tinge in her urine. Not only that, why was her mother looking at her urine? Does this mother typically look at her daughter's urine before it gets flushed down the toilet?
- I know some of you will probably find ways to find excuses for this person, but the whole situation seems kind of odd to me.
That's what happened today, when I was asked to see a consult for a patient with "hematuria" (blood in the urine). In every history, I find that it's a good idea to get a timeline, since it makes things easier to present later on to the staff physician. So, for this case, I asked my standard question, "so, when did you first notice blood in your urine?"
The response: "Oh, two days ago. My mother first noticed it and told me about it." (note: this was a 29 year old lady who is perfectly capable of going to the washroom on her own and did not require assistance from anyone else)
I continued with the history, but in the back of my mind, three things popped up almost simultaneously:
1) You didn't notice the FRANK BLOOD in your own urine?
2) How the heck did your mother get the opportunity to see your urine (and for that matter, why would she look at your urine)?
and if the answer to 2) was that she saw it in the patient's toilet, my third question was
3) Don't you flush?!?
I've learned, though, that some things are best not asking out loud, if you want to maintain the patient-physician trust.
In summary:
- I had a patient who told me she first knew she had blood in her urine because her mother noted this issue
- This was a grown, independent, patient, which makes you wonder how the heck she missed the red tinge in her urine. Not only that, why was her mother looking at her urine? Does this mother typically look at her daughter's urine before it gets flushed down the toilet?
- I know some of you will probably find ways to find excuses for this person, but the whole situation seems kind of odd to me.
Subscribe to:
Posts (Atom)