The uber patient

I have a patient who is 80, has HTN, PVD, CHF, CRF, UTI, MR, TR, and AFIB. Good thing she doesn't have COPD or DM cause that would be an abbreviation nightmare.

Hi out there...

No one reads my blogs. That's okay. I do.

Quote of the day

"What is rule number 17 about the kidneys?? The kidneys are retarded."

Census - 23, Number of patients with diarrhea - 5

So funnily enough one of our geriatric patients (doesn't really narrow it down, since they're ALL over 80) got C. diff and had to be isolated. Too bad for the other 3 ladies in the room. Cause two of them got it too. One poor woman was discahrged home and had to come back 5 days later to be admitted under "C. diff diarrhea". Have yet to witness what exactly C. diff diarrhea looks like (oooh boy and the nurses will tell you).

Another guy on our team, a token "non-geriatric" patient, is a 49 year old with decompensated cirrhosis. Over the weekend he was really quite bad with encephalopathy. Today though he was a little better and my senior best summed it up by saying, "Well, he was pretty rough over the weekend but his encephalopathy has cleared to the point where he's back to his baseline of apathy."

One of my patients said he would miss me upon discharge. I don't think I will admit to the same sentiment, since he used to call me "that little chinese nurse".

NYD

NYD - not yet diagnosed
=
NYD - ninety years & demented



Why do all of my patients have confusion/falls NYD? Because their kids aren't taking good enough care of them!!!!

Pre-game jitters

So I was on call on my first day of residency (Fri July 1). Kinda scary. PLUS it was a holiday. Double whammy. PLUS I had to work on the Sunday. Triple whammy. I spent the entire long weekend indoors.

It was a pretty nerve wracking experience for all I think because the whole ward was brand new, as well as the concept of the team. I am on the Acute Care of the Elderly rotation, which is basically like team medicine for old people. We have admission criteria which includes age >75. So, all of our patients are confused, demeted, or just plain grumpy. My pager only went off about every 15 minutes, constantly...throughout the day...and night....until about 11 pm. Then I had an hour or so to rest until inevitably one of my patients went into heart failure (supposedly for the first time ever). I stumbled my way through that one (never felt more unsure about ordering an IV drug) and finally got to sleep around 2 am. Got called a couple of times in the middle of the night for blood sugar problems (really...if the guy's got a BG of 17.8....I'm not getting out of bed). One other patient was so agitated that I had to order him some haldol, and he was snowed the next morning ("what happened to Mr. N??").

Number of comments on my new puma sneakers: 2
Number of times it was mentioned that I look too young to be a doctor: 1 (phew)
Number of times I referred to myself as Dr. so and so: 20+ (feels weird still)
Number of times I just referred to myself as Andrea: 1 (and they had no idea what I was talking about so I just went back to Dr. so and so

The second night on call was just as busy, but with no major acute issues. I had to see a woman in emerg with ALS who thought she had something stuck in her throat, and also suddenly could not speak. We couldn't figure it out, as she didn't have anything there, even after laryngoscope and suctioning. Poor woman.

Yay no more call until next Tuesday!!

Introduction

---

Now, don't say, "Oh, family medicine - that's an easy program" cause really...all residency programs are hard. Where I think I DID make the smart choice was being in a program that is SHORT, so that I can finally get on with my life. I think I made a good choice...I'll have a good career. Besides, I'm not getting any younger!

I was pretty anxious to begin residency on July 1st, as most people were, but I had the lovely added stress of being on call on my first night in a specialty that I absolutely dread - internal medicine. It's not really the theory of internal medicine that I hate, it's more the practical side of it that really gets to me: the endless family meetings, the inefficiency of ordering lab tests and the relative non-appreciation of the patients who feel as though they are being hospitalized against their will. And I really can't get too excited about discussing the evidence behind whether patients prefer green pills vs blue pills (actually, I WISH they would talk about stuff like that rather than stuff I have no clue about).

---