I suppose I'm long overdue for a post. I really think about writing every day, but I feel like my life is sort of dull so I don't really bother writing most days. That's lame, isn't it? :)
Anyway, it's Valentine's day, a day that a lot of people seem to blow out of proportion - either making a huge fuss over what they get from their honey or their frustration with a lack thereof. I think it's nice to celebrate love but we should celebrate it more than once a year. And we don't really need to celebrate with flowers, chocolates, and teddy bears. Those are better as surprises, anyway. As for my day, I plan to study quite a lot (for our midterm on Monday), maybe try on some wedding dresses with my mom, and maybe cook some special food with Chris.
Off that soapbox.
Medicine at UK has come to an end. It had a lot of ups and downs. A whole lot of downs. Patients who come into UK aren't your "average" patient. People who come to UK are sick. I've been caring for a man all week who I was on edge about every minute because I thought he was going to code on us and die. His liver was dead, his kidneys were failing, his lung was filled with fluid, he was yellow as a banana, and confused because the ammonia levels in his bloodstream were building up. We told him his prognosis was slim (I entered his lab values into a program and it gave him an estimated 97% mortality rate)...but he and his family insisted on him being a full code (meaning we do CPR and put you on a ventilator if something goes wrong). We told him it would probably just prolong his misery, but they didn't even want to consider it. I don't really blame them - he was only 52 but he looked like he was 80. I went to see him on Thursday and he was actually doing great, he was asking if he could go home. Thursday night he coded and is now in the ICU. I am curious to see what happens but I know what is ultimately going to happen. He is never going to get better.
"never getting better" is something that's really frustrating to me. As a doctor, if I can't make you better, I should just make you comfortable and let you be. But I still can't help but feel like that's a failure. Like we gave up.
Another frustration was that I had too many questions. I have a mystery patient. She's 44. She acquired type 1 diabetes at age 22 (old for Type 1). She needed a liver transplant at age 27 for "Hep C" even though she has NO hep C in her bloodstream now, and probably not then. Why did she need her liver transplanted? I have no clue. And nobody seems to care. She has two brothers with "Common Variable Immune Deficiency" that presented in their early 40s-A disease that presents almost always before 30 and is not that heritable. Since July, she'd been building ascites (fluid in her abdomen) and was coming into the hospital to have a TIPS procedure done to shunt the fluid back in her bloodstream, basically. She also stopped menstruating in July. I think there's a connection. Who just hits menopause when they're 44 and have no symptoms at all? Nobody else believes me, or at least nobody else cares! I want to figure out what the crap is wrong with her and basically everyone else just takes everything as it stands. Maybe I'm just not burnt out enough yet. Who knows.
PS- I am tossing around alpha-1 antitrypsin deficiency and hemochromatosis (her skin is so brown, but supposedly uses tanning beds) in my differential. A1-AT would be great but she has no lung involvement. Hemochromatosis would be weird for her to present so early. But why can't we just order the tests anyway? Maybe if we found the cause we could prevent the complications. Just sayin'
Anyway, UK medicine was frustrating to say the least. I felt like I knew nothing most of the time, was largely ignored, and we rounded for what seemed like an eternity. I liked the mystery but hated that no one else appreciated it. I didn't like that so many people in the hospital could have prevented it by taking care of themselves in the first place, and my tax dollars are paying for it. The more time I was there, the more I wanted to do peds. :)
Anyway, Chris just brought me in homemade heart-shaped pumpkin chip pancakes - how cute is that?! I gotta go get some before Patrick comes down and eats them all! :)
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