November 2, 2007

• The Story continues

  but before that here is my halloween costume
  
  
  
  Yes I was facebook. Drunken facebook. I was super poking people all night long, as well as having my wall written on, and occasionally hacked
  
  
  Found you waldo. More photos when i damn well feel like it. But now on with

  CONTINGENCY PLAN

  Two-POST CALL

  Alarms and buzzers were going off everywhere. Josh flailed about,
  seeking his pager, before realizing it was his cell phone. He shut off the alarm and glanced at the time. 5:00am November 1st. Time to begin pre-rounding on patients. It had been a long night of call, not entirely unexpected given the holiday. Multiple people had come through the ER, but he only had to deal with the traumas, most of which went to county, bless their overworked little hearts. Therefore, no shootings, and almost no motor vehichle accidents, just a couple drunken lesbians who hit a parked car, one wheelchair bound gentleman with some kind of animal bite, and of course the intoxicated zombie.

  So down to the floors he went, waking up each patient, and going over the standard 5 questions that are pretty much all any surgeon cares about.

  “Good morning mr/mrs [whatever]. Any problems during the night? Did you eat? Did you pass gas? Did you have any bowel movement? Have you been able to walk at all?”

  Almost every patient usually responded positively to the questions unless they were fresh out of the OR or had something really serious. Surgical notes weren’t particularly hard to write, especially after medicine. Last stop was 3rd floor, Mr Greenberg, the intoxicated undead.

  “Heh. With all those stitches in his chest and neck, he looks a lot more like a zombie now-too bad halloween is over buddy.” Josh didn’t waste time asking the surgical note survey, partly because he was tired on only 2 hours of sleep, mostly because Mr Greenberg was still intubated in an induced coma and unlikely to answer anyway. However Josh still went through the focused exam, hearing a regular, if slow rate and rhythm of the heart, clear breath sounds, and intact deep tendon reflexes. According to the computer monitor, the vital signs were stable, but the oxygen saturation and tempurature were a little bit lower than they should be at 92 and 97.1, respectively. “Hmm…he should be satting higher than that, but it’s still within normal range. guess i will let the nurse know”

  Bright told Josh not to worry about it as he had been consistently satting low, probably due to his asthma, and the temp was most likely due to a low fever, since his white count clocked in at 11. Josh finished all his notes and went off to meet with his resident for rounds.

  …

  Rounds passed by without too much pimping, mostly just a few questions on MRSA management, probably because everyone in the hospital was talking about the new outbreak of whatever the new super bug was that was resistant to drug treatment, and how much work it was going to end up creating for the entire hospital and ancillary staff. Josh went to chat with his intern about the plan for the day’s patients, aka “running the list”

  “Hey Raj-so what do you want me to take care of today?”
  “Hey Josh-not too much, just call radiology for the reads on those x-rays for the lesbians, talk to ID {infectious disease} regarding the bite on our guy in 72, and oh, what’s the status on Greenberg?”
  “Meh…white count’s 11, but we’re pumping him full of avalox and cefotaxime, should clear up. He’s satting kinda low for someone who’s tubed, but bright said she would keep an eye on it and call you if anything changes”
  “Screw that-she can call hector, today you and I are post call, and that means we are out by noon”
  “Fine by me, just letting you know”
  “Alright then let’s take care of this shit and call it a day.”

  …………….

  The next couple of days went by as usual. The lesbians got discharged, wheelchair bite was transferred to medicine’s care under ID’s recommendation, new patients came and went. Actually, more patients were coming than going, at least for those stuck on medicine. Apparently the new superbug had finally worked its way over to the northside, and several patients were on the floors in isolation rooms while the hospitalists tried to figure out what the heck to do with them. Also somewhat disturbing was that Mr Greenberg’s white count had continued to climb, reaching 15, well outside the normal range of 4-10; yet rather than being febrile, he was actually dropping in temp, far closer to hypothermia than anything else. Josh continued to exam his wounds for any signs of infection, but aside from the high white count, and low temp, everything appeared stable. It looked like Senor Greenberg was setting himself up for a long stay in the SICU.

  ………….

  Two weeks later, Josh was relaxing at Mickey’s, throwing back a few beers with friends and fellow med students Phil and Tammy. They were doing what they usually did, what all med students do when they gather: bitch about med school because they simply have no idea of other conversational topics anymore.

  “So Phil, any horror stories from peds?”
  “Where to start-I swear pediatrics might as well be vetrinary medicine. You are treating a bunch of animals who cant tell you what’s wrong, when it started, and the only way to treat them is to put up with their handlers…erm i mean parents, most of who are too obnoxious to teach their kids how to behave.”

  “Heh, well at least they don’t lick your face, man. What about you Tammy?”
  “Nah, ER is same ol’, same ol’. Lot more people with that new MRSA coming in and getting transferred to medicine”
  “Yeah we have a bunch of those people too…what have your docs been doing with em?”
  “Truthfully, nothing much…they come in sick, we give them drugs, it doesnt help and they either sit on the floor while ID shits their pants, or they spike a fever and die, clearing a bed for the next one in with the same problem”

  “You have had them die?”
  “Well, yeah, but mostly its the elderly and kids who are coming to us, and its not like they’re in great health to begin with.”
  “So what are you doing with them?”
  “I just told you.”
  “No, I meant the dead ones”
  “Oh, we kept one or two for autopsy, but the rest are either returned to their families for burial or burned”

  “You guys want to hear a freaky story?”
  “Yeah Phil what’s up?”
  “We had one of those kids. Caught the bug, spiked a fever…except you know how it is with young kids, you spike a fever to high you can go into febrile seizures. Well the parents swore up and down the kid died right in front of them, shuffled of this mortal coil, ya know? But while they were mourning in the other room, he up and crawled in walking a little funny but otherwise good as new. I reassured them that he seized, not died, but we admitted him to the MICU anyway…mostly to monitor, since no one else has managed to cure themelves of the new MRSA. I mean the fever is clearly broken, his temp is like 94, low if anything, but you know these hispanic parents and how every little thing gets blown out of proportion.

  “Alright guys, well I gotta go, things to study, lives to save, you know how it is…same time next week?”
  “Yeah, see ya later Josh”
  “Later man”

  …but it was only the beginning…

  TO BE CONTINUED
  

  • 8:23 pm
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