Medical Minute...however long it takes you to read this...

I"m not sure how many medical people there are out there who reads these, but I've decided every now and then to write on this blog some of the "events" that happen in Manhatten, and maybe to illustrate the differences in care in the few places I have been. A "house" pt for those who don't know are pts that must be presented to your attending, the pt is not under anyone else's care and you will be doing all the following up, plan of care etc--know the case b/c you will get drilled on everything you can think of later--there will be questions like the tx for blastocystosis hominis is? You can guess, you can research it, but you won't get it, the answer is not scientifically proven. On the other hand, a "private" pt doesn"t have to be presented so you have time to put everything together and you can relax. Between the 3 of us we carry about 23 pts, all INfectious Dz/HIV. Yesterday started about like this from the night resident...

So Mr G, here's an 'undomiciled' (gotta love that word)37 yr old pmhx HIV (CD4 count of 8), Hep a/b/c, heroine addict, necrotizing fasciitis to L arm, alcoholic, 2 skin grafts w/ MRSA and abcess presents w/ fever, chills, SOB, CP, weight loss, night sweats, unproductive cough, and pain to the skin graft on the L upper arm. Oh, by the way, he's house, oh...and...we're rounding in an hour...oh, MR. G ---with the PCP px, he's got a bactrim allergy... And Mr G, the lab doesn't do too much on sat, so we'll need you to do another ABG, serum cxs, another 12 lead EKG, another set of labs, and see if you can get a sputum sample. Get his other records from his last 3 hospitalizations, order another xray if you get around to it...by the way, change that dressing...and try to get a second IV line...If you need anything, just give us a hollar.....Oh, run the plan and assessment by us before hand....oh, and don't forget to glove/gown up...Be careful, and above all have fun!!

The first thought that went through my mind was--I wish I was back in St George...not b/c the hospital there is a paradise with nurses who you don't get mixed up with your homeless pts, or because the nurses actually help with the care, or actually give the medications, or order procedures, smile at you with dentition intact--no bling----they tell you when your pt has a HR in the 30s seizing, not noticably intoxicated, actually might physically check a BP, can recognize their pt out of a line up of all the people in that pts room, will give the guy who has never had a shower in his life a good scrub, speaks understandable English, have less than 9 patients, and will actually check the labs for you!! No my medical amigos, I thought of St George mainly because I like the scenery of the mountains out the west window.......j/k. So, when those checks seem a little lower than your pal who is traveling all over--seeing the world in their RV talking of "great things"............ don't be jealous y'all..... you could have 100 of us interns, students, and young docs runnin' the show... ............and how many residents does it take to put in an IV?? Just one--to call the nurse.

So the day did go OK mainly because the attending was fashionably late, but the Doc got me on the appropriate methadone dose for a guy who uses 10 bags of heroine a day--although I guessed and got the price of a bag of heroine at $10...Interesting cases...Oh well, we'll see how tomorrow goes...