February 5th, 2004

Nescafe rabbit

No, it's not TB, I promise...

Stuffiness and sore throat are beginning to clear up now. What's left behind is a lingering sort of borderline nasal congestion and a hacking cough as it drains into my lungs. Pleasant thought, neh? If I stay well-hydrated it's not too bad.

I woke up this morning after about 6 hours of sleep - came in to check the holdover board and pick up a new patient. No holdovers. It's a modern miracle, the ER resident says to me. So now my duties for the day include waiting to be paged when we finally do get an admission.
After surgery, this is such a relief. So comfortingly boring. Waiting for the team to gather for rounds again. Take two.
White Coat

So what's the afternoon plan?

Walking rounds this morning with staff, blew through our 10 patients, including a trip up to the burn unit that did not involve stopping by the pantry for ice cream, more's the pity.
No new admissions thus far. Went and had Quizno's for noon conference, which involved one lecture on the pharmacogenomics of Tamoxifen (insert image of me flailing to catch something that completely went over my head), in which I think they said there might be a genetic link to the increased cardiac mortality seen in the first year of the WHI. Followed that lecture with another one given by one of the residents from foreign parts; I am ashamed to say that his accent was too thick for me to understand his big words. His lecture was also of questionable quality, even had it been given in perfect English, and so I'm not even entirely sure what it was about. Uremia and CHF or Diabetes, I think.
We came back, and my chief promised to call me if anything interesting at all came up. It's nice not to have a lot to do, but a little weird. Feels like the calm before the storm.

Tomorrow night I take call, O Best Beloved. I may pick up a few patients, hopefully before the wee hours of the morning. The best call nights are when we cap by five, because then we don't have to see new people.

Have been discussing plans with the fourth-years, they think I should take remote PBL or Computers in Medicine for my July month instead of vacation. Apparently Computers in Medicine requires the writing of a 5-page paper on a topic of choice, and no other meetings. I could do that. PBL, likewise, if done remotely, requires only e-mail communications.

I wish I had interesting things to tell you - we have interesting patients, but I know them only peripherally. The diabetic man whose neuropathy is so bad he didn't know he was soaking his feet in a tub of scalding water. The twenty-something with small cell lung cancer, metastatic to his spine, who's on doses of morphine that would kill you or I. They haven't given up hope on chemo and radiation yet... The man with obstructive sleep apnea, all 350 pounds of him, who was doing okay until he got a nasty cough, wore out his diaphragm, and decompensated, now with right-heart failure, edema, and a general mess. The man with symptomatic bradycardia - he's 30-something, and his heartbeat is about 40, which would be potentially all right if he didn't keep passing out. They got a tracing when he passed out...asystole - flatlined - for several seconds. There's a scary thought. A gentleman with atrial flutter and a heart rate of 140, who'll need to be shocked back to a regular rhythm once we get him anticoagulated.

And my pager just went off. Down to do an admit H&P...
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