August 2, 2007

• Patients say the darndest things…

  Well now that you all know what a typical day for me on medicine rotation is like, I figured i would share some of the moments in my daily life that could have come right from episodes of scrubs, house, or any good medical show. Not grey’s anatomy, i said MEDICAL show. All patiens left nameless to protect HIPAA rules and regulations

  One intoxicated patient i saw had to be placed in restraints due to severe agitation and delirium tremens, which is basically seizures suffered from alcohol withdrawal. The next morning when we saw the patient in rounds, the attending did the quick physical exam and history and asked the patient at the end if he had any questions. The patient responded in a very calm collected, reasonable tone of voice, yes, I was just wondering if i could have a knife. When the attending asked why the patient wanted a knife, he responded, “so i can cut these restraints”. Perhaps you had to be there, but seeing this guy act like he was amazed he had to be tied down when only hours before he was yanking out iv lines and swinging at nurses was amusing to our team.

  One patient continuously kept apologizing to the doc for all the medical problems she had, to which our attending responded, “dont be sorry, if you didnt complain i couldnt afford my car, my house, or my phone” The patient said, hey is that one of those iphones? When the attending confirmed, the pt said, wow, so how many songs are each of my problems worth?

  I becoming something of an expert on MRSA infection, having had 4 patients with them. MRSA of course being methicillin resistant staph aureus, a particularly troublesome drug resistant bug that is somewhat of an endemic to chicago. It normally only causes illness in immunocompromised people, but by the end of the 2 months, if everyone on my team hasnt had it several times over, i will be very surprised.

  I am also becoming incredibly proficient at giving rectal exams to patients. Partly because my team know i am interested in GI, or perhaps just to have fun at my expense, I have performed more rectal exams than any other student on internal med rotation. And i only expect this number to increase, as our new attending is of the opinion  “rectal exams for all! yay!” – unless they are in danger of a heart attack. You may be wondering why…apparently a rectal exam can be stressful enough to precipitate a coronary attack. that would be embarassing wouldnt it? Cause of death-heart attack secondary to finger up the butt.

  A recent article in the NEJM came to the conclusion that obesity is contagious. That is too say, friends of fat people are more likely to become fat themselves. This brought me to a conclusion of shocking medical significance…put morbidly obese patients in the room with eating disorder patients. Chubby girls: curing anorexics since 2007. It’s science!

  Of course it is not all fun, games, and rectal exams. The last 3 calls i have been on, code blues have been called. For anyone unfamiliar with this term, a code blue means that a patient is crashing, and the first resident into the room is the one in charge of directing everyone in an attempt to save them. I have been among the first people on all three of the calls, which means i was able to perform chest compressions or operate the breathing bag while my resident did all the stuff you see on the medical shows, calling for epi, directing initiation and cessation of cpr, organizing defibrilliation.

  If you were to step back, a code blue almost looks like a head chef directing the preparation of a very special dish. There are numerous people running around in what initially appears to be a haphazard fashion, each with their own ingredient. The resident, or head chef, has to direct each one to add their ingredient in the proper order and make method out of the madness, or the dish will not come out right. And nobody likes a dead dish. Although, to fill in the lay community, real life is not liek the medical dramas. It is very rare for a patient who is coding to be brought back to life, and even those who are will still have electrical burns from the defibrillator, possible broken ribs from the chest compressions, loss of brain function depending how long they were without oxygen while we tried to revive them, and a host of other complications. So let me take this opportunity to suggest to everyone that you fill out a power of attorney and living will now, before you go to a hospital, because you never know when you might need it. And think strongly about your desire for rescusitation and intubation relating to your age and what condition might have caused it.

  Til then, i am off to study some more, until i have more stories for you all, a better way of telling them, or yet another rectal exam to do. I am becoming known as the assmaster round these parts. Lets hope i can fool people into putting a positive spin on that ;-P

  -J

  • 5:56 pm
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