| | After a month of working at the MTU, I think I'm enjoying it. Well, at least that's what i try to tell my self. Some days I function purely on caffeine. I love my patients. It may not be true the other way round at times. Some of the oldest and sickest patients are on my floor, and many of them were admitted with a gigantic list of issues.
Things can get complicated. For example, I had this one patient who presented to Emerge with shortness of breath and anemia. Aside from that she came in with a million other things such as: unresolving pneumonia, chronic kidney disease with baseline Creatinine sitting at 300 (normal would be less than 110), diabetic retinopathy and neuropathy, neuropathic pain, chronic obstructive pulmonary disease, yada yada. Don't even go to her bottomless well of medications. Following her from day to day was quite a mission. We didn't know what was causing her profound anemia, so we ordered a barrage of tests on her. We were considering Sarcoidosis (yes, this differential comes out on House MD quite a lot) at one point because she had some weird lung CTs, kidney involvement, some enlarged lymph nodes, and partly due to her ethnicity, but after working her up we decided it was something else. She somehow developed pericardial effusion, which is when you get fluid around your heart, and she had a pulsus paradoxus (it's this thing where you get a cool change in blood pressure with inspiration) of 10mmHg, which was pretty cool because i dont get to do that often. Anyways, long story short, yesterday, we finally managed to get an upper GI scope and Colonoscope done on her. We had always suspected her anemia was due to a bleeding somewhere in her GI tract, be it hemorrhoids or colon cancer. However, it turned out to be some oozing ulcers in her stomach. And now the shocker... she also had extensive melanoma in her stomach. What???? I was pretty shocked. I never thought you can get a primary melanoma in there. Metastasis from the skin, yes, but a primary?
Anyways, it was my last day there yesterday. I was a little sad, but I'll be moving onto Neprhology next which is less hectic(i hope). I need a little downtime too. Call nights at nephro won't be at the Emerge, which would be chilll. Stayed a little later than usual to finish off dictating discharge summaries and to write transfer notes on all my patients so that the next horde of people coming in to inherit my patients will know what's going on. You kind of get attached to them, as you see them everyday and they are your patients. I get quite good turnover, i guess because i'm such a great healer... lol. Anyways, my patients have been quite interesting, which also means a billion issues and a freakin long transfer note. There is this HIV guy i have that has all the opportunistic infections under the sun, but that's a different story.
Of course, last day at the service also means evaluations. I was a little surprised. Apparently i exceeded expectations in terms of knowledge. They did say that i was quiet. But my attending was nice about it. She said it is okay to be quiet, but sometimes it's good to show off that you know by answering questions. Oh well. Apparently i am conscientious and have good rapport with the patients. Well, i can remember a few of them who really liked me but some of them hated my guts because i kept coming in to examine them when they were trying to sleep. There was this little old lady, who, i can say was my favorite patient. Barium swallow showed a huge gastric cancer (for which she was crying all weekend and i felt sorry for her) but when we scoped her we found nothing. Telling her family the good news was wonderful.
The resident i worked with was a great guy too. All the residents, at least in IM, were really impressive. I'm only 1.5 years away from being a resident. I hope i'll be as good in the future.
One thing i do hate about this though.... i haven't had time to practise kung fu in 5 months at least. This freaking sucks. I tried to touch my toes and it hurt. I'm back to square one to where i was 6 years ago. I guess i'll try to set aside some time to stretch more.
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| | Posted 1/31/2009 8:31 PM - 11 Views - 0 eProps - 0 comments
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