| | Going into my nephrology ward rotation, I've never seen Diabetes as the devastating disease that it is. Almost all my patients who are having end stage renal disease have diabetes plus at least one of the following: destroyed sight, nerves, blood vessels, bladder and stomach function, and amputated limbs. It is sometimes very heartbreaking.
I know i'm not allowed to have favorites, but my favorite patient is this 40 something year old lady who has had every bad thing that one can't imagine happen to her in life. She looks way older than her age. I guess being so sick for so long does that to you. She can't even remember the last time she felt good. Most recently she lost a leg and her father at the same time. I see her first thing in the morning everyday: making sure her vitals are stable, good glycemic control, volume status, having a chat and focused physical exam, review dialysis orders, review her meds, write new orders, address any complications during the night, bring movies for her to watch, etc. As you can see, it isn't that hard to get attached to my patients. There are good days and bad days. Good days, i bring her a great movie i found and her face lights up. Bad days are like when she developed fluid in her lungs and we had to tap it and put in a chest tube for a few days. There are many other, sicker, patients who came in whole, had both legs amputated because of peripheral vascular disease, and are vomitting 10 times a day due to gastroparesis.
My rotation ended yesterday. This morning, after coming back from being on call at the other site, I gave her a call to see how she was doing.
Things were busy all month. I see my patients first thing everyday. I address any issues by either writing orders and getting it co signed by the resident/fellow, writing and calling for a consult in another service, and presenting my patients to my team during rounds. Lunch time was lecture/teaching time, and we get teaching in between and also on the floor. Almost as busy as MTU.
My team in nephro consisted of the attending staff, a fellow, a 1st year resident, and 2 clerks. Of course, you can't forget the nurses, who are all really sweet ladies (and refer to me as Dr Lee sometimes). One can't help to note that we looked like the United Colors of Benetton. We've got a Jewish attending, a Black fellow, an Arab, a white canadian resident, and yours truly, the Chinese guy. It wasn't a huge floor, so there were about 14 patients. I carried 4 patients, the other clerk 4, and the resident carried the rest. You don't usually get a fellow (in layman terms, a resident in a subspecialty, or a really senior resident), so we were really lucky. He was great guy who did lots of teaching and gave a lot of advice on the 'art of medicine'. The attending funny to watch. He is extremely hyperactive. He talks at the speed of sound, and compounded with him being always 5 steps ahead of you in terms of future management of the patient, i don't know what he is saying half the time. He is however, an extremely smart man who is part of the AOA (an american medical honor society) and who did his fellowship at Yale.
So anyways, the weekend is finally here. I'll be starting Cardiology clinics on Monday. I'll also be on call for MTU on Monday so it is going to suck. Final OSCEs and the Internal Medicine written exam is in less than 4 weeks. Fuck.
For now, I'll be happy going to breakfast at the local Greek grill on weekend mornings, and going to workout at the school gym. Spring is coming and the 10 inch thick layer of ice on the ground is melting.
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| | Posted 3/1/2009 3:51 AM - 7 Views - 0 eProps - 0 comments
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