Thursday, February 24, 2011

One step forward, two steps back

So I was on a case a while back. Patient was elderly (I mean like super elderly) and had a ton of problems which after a weeks stay in the hospital were getting better. She was coming off her broad spec antibiotics, she was eating, her pain was gone, the only thing we couldn't get her to do yet was get out of bed, which apparently won't stop you from getting the boot from a hospital anyway. Everything was good, until I came in the morning we were going to d/c her and she had spiked a white count. No fever, no tachycardia, just a 5 point jump in her WBC's overnight.

I about shit a brick. I had literally the night before written a note stating "watch out for C. diff colitis due to broad spec antibiotics and frequent watery stools," and C. diff is one infection that can hit without prompting a fever. On the contrary, Mrs. Super old also wasn't doing much and we had fluid overloaded her once during her stay, so she was having some atelectasis and effusions (google it if need be) so my attending was afraid of pneumonia (the elderly apparently don't need either a fever or white count to have an infection, thus I'm staying away from geriatrics). Chest x-ray was ordered and another round of different antibiotics was started.

Later that same afternoon, we visit the Gerry's chart to see what her x-ray showed, and my attending finds a progress note from the primary on her case that states BOLUS OF STEROIDS WAS GIVEN YESTERDAY. For those in the crowd that don't know this one I'll save you the trip to your search engine: steroids=white count elevation. Fuck me sideways Martha, I really wish I had this piece of information when I looked at the chart 15 hours after the bolus was given.

This showed two aspects of medicine that need to be addressed. One is doctors' handwriting. The whole reason this progress note wasn't on the charts is because the attending likes to dictate or type them and put them in later, making sure they're legible. But they're daily progress notes, which should be in the chart THAT DAY. Granted, it was an oversight on my team's part as we didn't flip through the couple sheets of orders to find it, but still. Can we not have something that lets us be legible AND have notes on the chart the day they're written? Trying to be legible shouldn't cost a patient mistakes in treatment and a delay in getting the hell out of a hospital bed.

Wednesday, February 23, 2011

I might have LOL'd

recently seen on gchat->

friend: do anything exciting lately?

me: no
me: unless you count cutting people open and playing with their guts exciting

morbid? maybe a little. insenstive? GTFO

....and for the record, I find it very exciting. So much so I don't care about pulling 12-16 hour days without lunch(suck on that one unions)

Tuesday, February 22, 2011

O....M....G

For those that don't know, when you work inpatient, you get used to the population having a certain....aroma. The kind you get when you're deathly ill and not bathing appropriately. It's a completely understandable situation and you get over it...unless you meet that stench in the clinic.

We had a lady come in today with a BMI roughly in the low to mid 50's (important in a sec) and I got sent to see her first. I notice on her chart that she reports a 1/2ppd smoking history, which is complete BS because you could smell it on her through the door. Being a gentleman, I left the physical exam for when I could be supervised by my female attending (word to the wise, don't try an exam unsupervised on a female without at least SOMEONE else there). Unfortunately, I'm on gen surg at the moment, and we HAD to do an abdominal exam. I really don't mind doing one on obese people with the exception that you're not going to find anything, its the fact that we quickly found out this chick rarely bathes and certainly doesn't hit in between her folds. The smell alone was overpowering. Putrid even. Bleh.

So in conclusion, shower for f**k's sake. Please. Thanks.