If you missed it: Part 1 Part 2

Then it’s time to meet my attending. Normally I have a lot more time than this, so I write my notes super slow and make my handwriting pretty. This morning though – no time to do that so my handwriting can still be read, but it’s a little on the wild side.

We start in the ICU. This ICU is cramped and uncomfortable. The patients here are not of real interest, and I don’t know their cases well. The other ICU has an interesting case though. Normally, I have more time so I would have looked up this patient and gotten their story, but not this morning. The attending I’m with needs to make a personal call, so I scope out the scene first.

I look over at the patient… hrm. I don’t have a good feeling. Attending comes in, looks at the patient and mirrors my feeling. Nursing comes over and mirrors the same sentiment. Patient has end stage liver failure and was found unresponsive. Patient is waiting for a transplant. Labs looks awful. Patient’s liver failure is due to Hepatitis C, most likely from IV drug abuse. One could say patient’s liver failure is their fault, but in the end to me that’s not what matters. Patient has a family, a family that now has their loved on in the ICU looking awful, and that makes me feel upset. As we work this patient up, I see another patient, an older person on a ventilator occasionally moving their head. Patient has gloves over their hands, maybe to prevent them from pulling things out? I wonder about the sense of all of this, people who are old enough to have had “a good life” but are now in the ICU ventilated, likely to get some kind of other infection, bed sores, etc. Is it wrong to allow patients to die without coming to this?? Something to think about later.

Back to the original patient with the liver failure. Patient needs to be at a different hospital. Go to visit the patient. Look for fluid in the abdomen. Discuss some of the physical exam signs of fluid in the abdomen (ascites). Some of these… well I have seen before, as my father’s oncologist showed me. Hrm. Kind of painful. But everyday is kind of painful because my Dad is always somewhat on my mind. Just right under the surface, and there’s always something – and really it’s just because my Dad is always on my mind more than anything.

We finish up, and go see the various patients I had seen on my own. As we go visit them, I update the doctor about what I had found and any changes – and what the plan is from here on out. It’s fairly routine, there’s nothing unusual about this part. “Mr. Smith is the 45y/o male who came in with nausea and vomitting, since admission he’s been doing well, no further emesis (vomitting) and tolerating a soft diet….”

So that’s the basic gist – it changes by service but that’s close to the general scheme of how it goes. You see patients, write notes, see patients with attending and report on them.