Whoopsie
signout | August 19, 2008Last week, I got invited into my program director's office for a little chat. My previous week's attending had emailed him about a complaint made by a family with regard to the way I'd handled an event on the general pediatrics wards.
The exact events don't really matter: all you need to know is that I made the mistake of relying on second-hand information while something fairly concerning was evolving. Although nothing untoward came of this, the perception of a delayed reaction on the part of a patient's family was enough to provoke a complaint.
And another thing, said the email. For part of…
signout | May 12, 2008"What I want you to do," I said, "is breathe in deep, then blow it all out like you're blowing out birthday candles."
He focused his eyes in concentration and blinked a few times, then did as I'd said, aiming for the finger I held in front of him.
I listened to his back with my stethoscope. "Again," I said. "Again. Again. Good job! Again."
His mother sat forward in her seat and breathed in sync with her boy, her face softened from the suspicious glare she'd trained on me a moment before. After I'd listened to every part of the kid's chest, I put my hand up for a high five, which he gave me…
signout | February 23, 2008It's been a while.
I've been in a demoralizing, soul-sucking stretch of rotations for about two months. Suddenly, sleep has become more of a priority than ever before, and documenting the details of my crappy life seems less important and ultimately, less useful than ever. Still, you people seem to want to taste of every plateful of shit that's placed in front of me.
One of the more recent combo platters was served a few weeks ago, when I was on a pediatric emergency room rotation. My first night on, I saw a clinic patient of mine who had been sent into the emergency room by one of our…
signout | July 4, 2007I've started my second year of residency with a rotation where I don't really function that differently from an intern. Our job descriptions are almost exactly the same: arrive stupid early, gather data on several sick people, round with our moody attending, and run around following up on details for the remainder of the day. The care of most of the patients on our ward is pretty specialized; under the fellow's supervision, I play at subspecialist-style management, but my actual decision-making is limited to basic inpatient medical issues.
Most of the time, I feel just like an intern.…
signout | June 27, 2007"How many times you poke me?" she asked. Then, in her heavily accented English, "Dr. Better never took this long for LP. Five minutes, always."
I made empathetic noises, apologized a few times, and tried to focus on the needle I was moving in and out of her back. I'd done four lumbar punctures before, and felt I was good at them. Wasn't I in the exact space where I needed to be? I stopped and felt again for her spine.
On my first day on the adult hematology-oncology service, she'd been described to me as an anxious, passive-aggressive woman who hated our hospital. She created traps for us,…
signout | February 2, 2007A few days ago, I posted here about a recent ICU admission of a patient with pancreatic cancer. Her admitting diagnosis was septic shock, and I'd initially included some detail about septic shock to help illustrate a clinical dilemma in her treatment. Although that portion was ultimately edited out, this is how a snippet of it read:
In septic shock, the blood itself is infected, and byproducts made by the infectious organisms cause the blood vessels to become dilated and leaky. The danger of septic shock is poor perfusion of important organs, like the brain, the heart, the kidneys, and the…
signout | August 8, 2006It was bound to happen sooner or later: I finally broke someone.
Last Thursday, we admitted an 84-year old lady with bad disease of her kidneys and their vasculature. Her kidneys were too sick to make urine, making her a good candidate for hemodialysis. (In hemodialysis, a patient's blood is circulated through a big machine that sucks waste and excess fluid out of the blood-sort of an out-of-body kidney).
The goal on admission was to manage her acute issues, find her a slot for long-term dialysis as an outpatient, and send her home. Her most acute issue? Her very high blood pressure: she…