Thursday, September 13, 2007

Trial by Fire

I did another "mini" 10 hour shift today at the main teaching hospital:  Buffalo General Hospital. 

I am going to get on my soapbox today and rant about another reason for my dislike of nursing homes.  Why?  One of my patients today was a nice, pleasantly confused almost 90 year old lady who's initial diagnosis was "ischemic fingers."  Ischemic = no blood supply, so I quickly went and saw her only to find that her purple-tinged fingertips quickly turned pink when I put my hands over hers and warmed them.  I waited to see if they would quickly return to purple, but they didn't.  I looked at her other hand.  Nothing significant.  I looked at her feet.  Perfectly fine.
She was unable to answer my question of why she had been sent, by ambulance mind you, to the hospital.  I got the number of the nursing home and called.  I was "connected" to the nursing supervisor's voice mail and left a message.  She never called back.  Finally, her granddaughter showed up saying she had received a message that her grandmother had been sent to the hospital with "blue hands" and needed "a vascular study" to determine why.  When she looked at her grandmother's hands, she said they weren't much different than usual.
My attending and I looked through my patient's paperwork.  No transfer note.  No current admission note.  Finally, one piece of paper stood out:  a patient progress note which stated that this a.m. the patient had "refused her medications and spit them out."  My attending stated that the patient was probably "dumped on us."  He said the staff most likely did not want to deal with her and sent her to the ED.  In the time it would take us to evaluate her, the nursing home staff would finish their shift, and she would most likely return when they were leaving for home.  Seriously?
I do have to admit, she was very well kempt and neater than some of the nursing home patients I have seen.  And, hergranddaughter seem to be actively involved and saw her on a regular basis.  But, just how annoying could an 89 year old be so that you'd send her out?  I almost thought my attending was being fascetious but he proceeded to give me his rant of nursing homes and this one in particular, so I am assured there must be some truth to this.
Anyway.  We drew the usual labs, took a chest ray and EKG to verify there wasn't anything unusual happening and sent her back.  Another learning experience for me.
Today I managed to see 6 patients:  the nursing home lady, a gentleman with an inflammed wrist - most likely gout, another drug reaction allergy, a gluteal (butt) abscess which I almost got to drain but which the surgery intern drained, a gentleman with a bladder infection and dehydration, and finally a very interesting case of a gentleman with kidney damage because of exposure to a high amount of gold who came in because of fevers.  He developed a number of complications because of the medications he was put on which I will have to research since I haven't heard or read about them since med school.  That's it!

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