Tuesday, July 25, 2006

"Ah, there's the rub"

Last night I was up on call all night for the first time. Usually I have been able to get at least half an hour of sleep, but not last night. I had as many patients as I am allowed to take by midnight, plus the hospital ran out of beds so no more for us anyway. But I still had to do orders and histories and physicals and a lumbar puncture (attempt), teach my med student, etc.

My team had one of the most pathologically interesting call nights my senior had ever had. Some of my patients included:
  1. 10 year old boy who had Hodgkin's Lymphoma at 3.5 and now has horrible restrictive heart disease and really bad ascites and can barely breath his lungs are so compressed by the fluid in his abdomen and his intestines are pushed down into his scrotum through his indirect inguinal hernia. He's really adorable, though. Speaks only Spanish. I let him listen to his own heart (which had murmurs and rubs and gallops and is basically working really hard to keep beating) and he said, "Gracias." We are trying to figure out exactally what he has. He might need a heart transplant. I thought right away that he needed the fluid taken out of his peritoneal cavity but apparently they don't do that in kids much and so no one felt comfortable supervising me (even though I've done it before).
  2. 10 month old boy with some unknown congenital abnormalitiy with all sorts of things wrong with him in for really bad reflux. He has never eaten by mouth in his life (has a tube that goes directly into his stomach) and his Nissen fundoplication slipped and needs repairing. He is a sqirmworm fussbudget and his parents are very attentive and concerned. Sad part is that thay also have a three year old daughter who they rarely see because they are always with this little guy.
  3. 10 month old with intractable epilepsy.
  4. 5 year old with bad bloody diarrhea which turned out to be both E. Coli (o157) and C. Diff. My senior paged me when she saw the results, "I hope you washed your hands after seeing him!" We put him in contact precautions immediately and started antibiotics.
  5. 3 day old girl with possible sepsis who was so dehydrated that none of us could get any spinal fluid to test for an infection there, despite trying a total of 6 times. Poor baby.
  6. Patient who I had there for a while who went home today who had both of her kidneys removed because they were polycystic and taking up her entire abdomen and then some. She developed a reactive knee inflammation.
  7. 14 month old with Down's Syndrome and short gut whose central line broke and started squirting blood. Thankfully they could repair it without any further damage.

And then the rest of my team got some interseting patients, too.

  1. Pyloric stenosis
  2. Gluteal abcess v. cellulitis

I have a lot of decompressing to do about the night and would like to write more, but have to present a paper tomorrow which I have just printed and not yet read. Oh, to sleep, "to sleep perchance to dream"? I'll take the rub at this point!

2 Comments:

Anonymous Anonymous said...

I haven't been here for awhile... it is good to read about your life. I pray for you to "sleep fast" as I call it. Love you!

5:09 PM, July 26, 2006  
Anonymous Anonymous said...

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7:52 PM, August 05, 2006  

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