Far Side Cartoon - Gary LarsonI really don't know what to write about. It seems pretty basic at the moment: I show up for pre-rounds about 0630, get all of my patients' information, start writing my notes, formal rounds are at 0800, they end around 1020, we have Medicine Morning Report at 1030, that lasts about an hour, we then come back to the unit to finish up notes and assignments for the day, you sign out your patients around 1600 unless you're on "short call" such as I was tonight in which case you take admissions until 2030, and then come back the next morning and start all over again.
My patients are interesting:
An 18 year old with Guillain Barre Syndrome that has completely taken over her nervous system and left her completely paralyzed. She's on a ventilator and getting treatments to try to "clean" her blood of the antibodies that are affecting her nerves (plasmapheresis.) Best case scenario is that she will start to recover in about a week (she's already been here a week) and come off the vent. Worst case is that she will need to have a tracheostomy placed and will take over a month to recover from the initial insult. We'll see. Right now she's battling a pneumonia. However, she's young and healthy and should do all right.
I have a 39 year old with bad insulin dependent diabetes who came in with Diabetic Ketoacidosis. Oh yeah, she's been in and out of the hospital for over 10 years with the same thing. So much so that most of the staff know her and her history; which includes experimenting with multiple drugs, not taking her medication, and generally not caring for her own health.
My last patient has lupus. She also doesn't like to take care of herself. Her diet consists of pizza and potato chips, sodas and snacks. She's got a heart condition where too much fluid makes her short of breath (not helped by her years of smoking) and too little fluid causes heart issues since she needs a higher volume to maintain her blood pressure. However, the fact that she's also "non-compliant" means she's a frequent flier as well. Also, I hate to say, but she's something of a slug: doesn't like toget out of bed and wants everything done for her.
We just started yesterday and not much happened so I didn't write. I had short call today, but I was protected by my "white cloud" and only got the 39 year old as an admission this morning and nothing else. I have Grand Round Wednesday tomorrow after I pre-round on my patients. Then I will "clean up" for a couple of hours afterward.
We'll have to see how things develop over the next couple of days. For now... the fun is just beginning.
