patients you want to strangle

i worked my first full 12 hour shift, I must say better than being on call but still a very long time. My first patient was a woman who spoke zero English and for whom I had to struggle to get anything out of a translator. Atleast she smiled and was cooperative. My second patient - was a homeless man who apparently came in for chronic back pain. When i went in he was sleeping (even though he had just arrived.) I tapped his arm and attemped to rouse hiim. He briefly fluttered his eyes at me and then quickly closed them again. It was like pulling teeth, begging, pleading please Mr you need to answer my questions, we cant help you unless we know whats going on, you need to wake up, you need to answer this, if you answer my questions i'll leave you alone and you can sleep, i know you are sleepy but i need to get t his information from you in order to help make you feel better. He would whisper his answers, and i would repeat myself to speak louder. Then he would grouchily shout his answer, annoyed that I had asked so many times. I felt my tone getting angrier and angrier. Finally I just skipped to the physical exam. Possibly still frustrated from trying to take his history I about gagged when i had to lean over him and listen to his heart, as i could smell his scent, his odor, his energy. There is nothing i hate more than hot breath breathing down on me. I hated this poor patient, who was feverish, likely intoxicated, and as it turns out positive for cocaine and benzos. My resident finally took over and maybe because he is a man was able to get the patient to cooperate - atleast more than he was with me. this patient made me feel like not helping him and we are not supposed to feel that way about any patient.

on being a guide

I stepped into the Peds ER, was asked to bandage an ankle. And before I knew the two quiet latinas sitting at their sons bedside were asking me all the questions in the world. does he need follow-up, what is this medicine the doctor prescribed, can he get a note for school to use the elevator, is he going to be ok and some. Move to the next bed to find a mom with a chronically ill son who is monolingual spanish and is dealing with complicated seizure medications, who calls me over to ask what fluticasone is. they prescribed it to her son and she uses it, but she didn't know what it was for. Flash to walking to lunch out on the quad, atleast two people ask me for directions, everyday, anytime. My classmate turns to me and says, wow people always ask you for stuff? how do they know you can help? Guess its these pretty brown eyes, tanned skin, unkept curly hair and approachable face.

procedures

It was a better night, I got to write up one of the new admits - vaginal bleeding. Not too complicated. I don't know where all the time went becuase reall did nothing else but sit and wait for her labs and US to come back. During that time my resident told me I could get a chance to do a Lumbar puncture on a woman with a suspected subarachnoid hemorrahage. He asked if I'd like to watch or just do it. Attempting to break free of the timid shroud that overcomes me, I said yes i'd like to try.
two hours later I was gowned up, wearing sterile gloves and a huge mask shield. My resident positioned the patient, betadined it all. I layed out the sterile field and then he gave me the needle to anesthesize the area. I injected all of the lidocaine. Then I got the lp syringe and slowly guided it through checking for csf after about 3cm. I repeated this over and over, removing the needle then reentering. At times my resident was engaged inanother conversation not even looking at what I was doing. I thought I hit bone and my resident checked it, and indeed it was not bone, I had got it. He handed me the manometer and we measured the pressure. At this point i started to feel nauseous and light headed. I struggled to hold the manometer straight as I felt I was going to keel over. Got throught it and he handed me the vile to collect the csf fluid, drop by drop. At this point I could no longer take it, I told him I felt sick and he said go ahead and step back get some fresh air. Which I did. I felt my body gettign extremely hot and then cold sweat. I stepped out, pulled off the gown and went to splash water on my face in the bathroom. I wasn't scared, I wasn't grossed out, I wasn't nervous - I don't know what came over me at that moment. I stepped back into the room and even the patients daughter asked me if I was ok. I did it. The resident said good job. hopefully the next time will be easier

night shift#2

either I'm lazy or I keep getting residents who think I'm lazy, or residents who are lazy and don't want to deal with having a medstudent. in either case I finally got my own patient to talk to - but my resident decided it better he write everything down - as if i can't write or i might write the wrong thing. ugh. While talking to my patient the nurse informed me of all the other traumas going on - my resident didn't even tell me. one motor vehicle accident vs pedestrian, one bar fight, and one 15 ft fall after removing xmas lights. I felt so awkward as everyone seems to have a purpose and you are just there. and in everyone else's defense its not like they have time to tell you what your role is. later i asked my resident and he just said, he's some scissors you can cut their clothes off. ok. oh and bring warm blankets. so thats what i did. cut shirts off if the patient had a c-spine collar. That and paced around the 12 room circle, looking around, peeking into rooms behind curtains. Checking on my patient, making sure she was comfortable, makign sure someone was doing something for her. All she wanted to do was eat her food. But we had to wait for labs, Cxr etc and determine what might be causing her problem before we let her eat in case we were going to do "something." what i have no idea. finally after 4 hours in being in the ER we let her eat. And finally after being in the ER for 4 hours my resident went in to listen to her lungs. and even then she never got his full attention. neither did I. i hope to get more procedures next time. atleast a foley for petes sake. its almost a disadvantage being a fourth year becuase everyone thinks you just want to skip out and go home. and no! i just want to learn something, have some responsibility, before I become an intern and have no idea at all.

Night shift #1

Well truly not as bad as I had thought. I only worked 4 hrs. And it was busy - but slow for me. I just stood around and ended up talking to the three patients my resident was caring for. There was one nurse assigned to those three - who was just almost frantic all the time, and had his preceptor nurse looking over him, correcting him, grilling him. My resident is a tall skinny latino guy with glasses. He was so busy and yet i have no idea what was so time consuming. i swear to you he was pacing around, making phone calls, writing stuff down on the papers, ordering the nurses around, breathing coffee breath down on me, and he kept on tell the patient, "sorry sir, i'm going to get to you soon." Craziest part is, there is a waiting list of 100 or more waiting to be seen. Some have been waiting for 12 hours for their turn to come in to one of the rooms and be seen. Depending on acuity they will be seen sooner or later. The guy that got in was an older man in his sixties with a rare condition acquired after a sting from a yellow-fish in the Alaskan waters where he worked as a fisherman. The venom caused him to get Endocarditis - this is extremely rare, and the last documentation of such an occurrence from this fish was in 1958. As a result this poor man has received three consecutive aortic valve replacements. The first was from a cow and somehow fell out, causing him to go into immedicate congestive heart failure. The second was porcine and somehow became ineffective over time and was replaced with a mosaic porcine valve. today this man was presenting with acute stabbing, squeezing pain at the precordium, radiating to his jaw and left shoulder and occurred during exertion, with diaphoresis, nausea. The pain was 8/10 and lasted for an hour until the paramedics arrived and gave him some aspirin. In the ED he was given nitro, serial EKGs, and troponins. The EKGs were negative for ST elevations (meaning no ST Elevation MI) but the Tn returned as .14. Nitro drip was started and teh cards team consulted - calling it Non ST elevation MI. The poor guy was homeless on his way to see his daughter here in LA. We took his boots off to look at his feet and feel his pulses - and boy did those feet stink! the room just reeked. pobrecito.
The other patient we had was not too interesting, latino guy with 9 days of watery diarrhea and three days of RLQ pain, here to rule out appendicitis. What was the most interesting was his phone conversation to his mom that I overheard. He called his mom and said, "Ama pues aqui estoy. todavia no me atiendan. Pero me toco un doctor chicano y una chicanita." Pretty awesome. Doesn't happen very often. He told me he thought the white doctors treated him worse, he said he felt like they didn't care, they would send him home with pain killers y ya. they never tried to figure out what was really wrong with him.
ANyways, most of my night was spent chopping it up with these two guys. About life, diarrhea, and fishing in Alaska.