February 18th, 2004

Lanslebourg - lamp

I work in a hospital so poor the ATM is out of money...

And so, O Best Beloved, I come in this morning to check on my one patient (why do I always have just one patient? The other students have 3. Somehow, I get patients who come and go, ephemerally. Somehow, it's always that way) and he's doing well, but his white count is up.
I did a search this morning, read about pancreatitis. Have some questions about the way he's being treated, but then so does the rest of my team. Switched to a broad-spectrum antibiotic with good pancreatic penetration although I don't think they did it for the reasons I was thinking. (Medline question - do we even need antibiotics in someone with mild to moderate pancreatitis?) He has a rising WBC so we're worried, especially with his fever. And the ultrasound shows cholecystitis (inflamed gall bladder) so he's going to need that out too. Surgery wants an ERCP because they can, we think. They shouldn't need one, he's passed the stone and his LFT's are getting better. They have an NG tube down for the same reason, it seems, because he hasn't been vomiting since he got here. Silly Surgery.

Called O to tell him that I only have one patient. He'll fix that.

Did you hear, Evelyne-the-PharmD-student says to me, about poor Mr. V? I hadn't. He went to get his EP study and died.
V came in with a foot ulcer that needed some IV antibiotics. He had a bad heart, we knew that. We didn't expect, however, that he would suddenly go into a fast but stable V-tach. We also didn't expect that it would take 12 hours and all the drugs at the cardiologists' disposal to break him out of it - since his pacemaker was going spastic trying to stop it and had to be turned off, since shocking him didn't work. But they did break him out of it, and they scheduled him for an EP study. That's where they go poking around in the heart to find out where the bad section of heart is and *zot* it. It's a dangerous thing, because you're inducing arrhythmias, but it usually works out okay. And they only do it when things are dangerous to continue the way they are.
Apparently, they found two and zotted them, then he went into V-fib and they couldn't stop it. And he died on the EP table, in front of a room full of cardiologists. Go figure.

And now it's time to go to lunch and learn about the Gopher system here. I need more Gopher education, oh yes. Besides - free pizza, who can complain?
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Nescafe rabbit

Burning the midnight oil...

I miss my Angel. I miss my Angel an awful lot.

We capped our quota at 1815. I wrote my two H&P's - one on the computer, one on paper; they don't matter since the residents have to write their own and all - and had dinner, hung out, installed BitchX (well, unzipped BitchX) and discovered I don't know how to use it at all. But I did manage to connect the right username to the right server to the right channel and can talk with Angel that way.
Wow...Tranquillity will soon have me right back to command-line everything, because of this bloody evil internet access. Thank havens PuTTY works so well.

Ran out suddenly when they called a code 99 on 3N. That's a Code Blue, for those who know that terminology - cardiac arrest. And it's on 3N, the pediatrics floor, the worst place to have a code. There's no equipment there; I know - I worked up there.
Encountered Jenny on the way out. False alarm. Thank God.

S has a run of dying patients - three have died or are dying, including the lady with the stroke who is now back on our service. She's passing large amounts of blood, she's always been anemic, she's now a complete DNR who wants nothing done, not even maybe blood pressure support, and she's going down the tubes. She's quickly approaching the point where we refer to patients as trying to die.
And then there's the man on the vent who we know has previously said he doesn't want anything done. His family wants everything done. We're going to have to unsedate him and extubate him, most likely, just to find out that he doesn't want us to put the tube back down again. Why did we put it down in the first place? No DNI order from this admission. No living will. No advance directives. These things are important, O Best Beloved.

And S got my mail and signed my note, and it's 11 PM and I've been holed up up here for the last many hours, while the others on the team were watching the IU game. But I got to talk to my Angel, and I have the same relatively comfy call room I've had the last few calls, and in the morning I will be able to finish my MEDLINE search about pancreatic diagnostic tests.
Lindy is an angel, I am firmly convinced of it. She has her moments, but there's something wonderful about her, and she's always there when I'm beginning to panic. Thanks to Lindy, I have copies of the packets I'd lost from orientation (where is all my orientation stuff? It's all gone missing) so I can really be semi-prepared for conference on Friday. I just have to type up the H&P that I've sketched out already. It shouldn't be hard.

It's time for bed, I think. Goodnight, O Best Beloved.
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