Thursday, March 27, 2014

MICU rotation, part 1

I'm pretty sure I'm going to need 2 posts to talk about what I observed in the MICU, it just REALLY blew me away. I didn't have much to say during this rotation, no thoughts on care, because obviously almost EVERYTHING was COMPLETELY over my head! Except, one case of COPD of unknown etiology until I asked about the occupation of the patient. And that happened to be in the chemical industry, so it was no surprise that an illegal immigrant working in a chemical plant, likely without the proper respirator equipment would have full blown COPD with heart failure at the age of 53.

Anyhoo, almost every patient on the floor was on a ventilator. Including a patient whose family I met at the nearby cafe which was on the same floor and around the corner from the MICU. And in the strangest form of irony, this was also the patient that coded while I was in the MICU. I accidentally met the family of the patient when I thought I was lost and was asking people I saw in the area if I were in the right place. The sister of the patient told me that the doctor I was looking for was her sister's doctor and that the doctor was a very nice lady (which she was and REALLY sharp too). I told her that I hoped her sister would have a speedy recovery and she slowly shock her head no then her head dropped down for a second. When she looked up, she had tears in her eyes and she replied that no, her sister probably wasn't going to be OK. And to that I said that I would pray for her sister and family anyway and I reminded her that God has the final say. At that point, it was time for me to report to the MICU.

The first patient I saw was the man with the advanced COPD, followed by a terminal case of squamous cell carcinoma of the throat, a case of cirrhosis of the liver, a brittle diabetic, and finally the sister of the woman I saw at the cafe, a case of AML which had not responded to treatment (As I understand it, AML is the worst Leukemia to have). The AML patient was my age 47, and had been diagnosed 4 months ago. Unfortunately, she wasn't responding well to treatment and had been in the hospital for the past 5 or so days. She was one of the last patients I saw and when I looked in her room, the sister I had seen at the cafe looked at me as if to say hello and I responded by smiling slightly and nodding my head.

Our group was just about done rounding when I heard all kinds of alarms going off and all the doctors in our group headed straight for the room of the patient with AML. Her head was tilted so that it was pointing down which I assumed meant she was having a blood pressure problem but I don't know for sure because I had to leave before rounds ended (I'm going to check with the doctor to see how this patient is doing, our being the same age struck a nerve with me). What I do remember is that she had had problems the night before due to an improperly placed Dobhoff tube causing a pneumothorax. A pneumothorax that was missed by the Resident and caught by the Attending who was none too pleased (Gosh, being a Resident must REALLY be hard). And I could tell the Resident who missed it really cared about the patient, unlike the 5'2", balding Jewish Resident who I overheard calling rounding "a bunch of crap". (He had on a Yamaka which is how I knew he was Jewish, and with Jewish ancestors, I'm comfortable calling his arse out!). I digress, I was happy that the patient's sister had already left when the emergency began but I'm pretty sure she was called back in. When I left, she was stable but her prognosis didn't seem very promising.

The other patient I remember well was a brittle diabetic, a Black woman who not surprisingly, was "very well nourished" and around my age too. In fact, EVERY minority I saw on the floor was overweight, reminding me that minorities really gotta' work on NOT "digging graves with forks". In her case, her diabetes wasn't well managed though I didn't really know why besides the fact that she looked non compliant based on her weight and poorly managed disease though I know the 2 aren't always associated. However overnight, her feedings had been withdrawn for reasons I can't recall. But what I do recall was that she was given 2 units of insulin in a fasting state so needless to say, things weren't looking good for her during rounds the following day. I also recall that this patient was assigned to the balding Jewish guy, and my immediate first thought was that his flippant attitude about rounding seemed to be carrying over into his bedside manner. So my question then became how in the hell did HE get into medical school?

Honestly, these are the kind of situations that have always worried me about going into patient care, what do you do when the person you're rounding with or are in school with seems to not care about what they do? It would be so hard for me to be silent knowing that my silence could cost someone their life, literally. But then I've already lost 2 jobs for not being willing to stand idly by as life threatening decisions are made, such as passing off bad data for a clinical trial. I just pray and I pray REAL hard that God doesn't allow anything like this to happen around me. Because I know if I were the patient, I'd certainly want someone speaking up to save my life.

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