In the Life of a Fickle Intern

August 26, 2012

The Patient Who Cried Wolf

Filed under: Daily Lowdown — dailymedicine @ 22:17

One of the most frustrating things about doing Emergency Medicine is that I HAVE to see a lot of frequent fliers, a term we call patients who come to the ED often. I don’t usually mind, but a lot of times, these are the same patients who are a little meaner, demand a little more, and complains the most. Many of them have some sort of motive, whether it be pain medication, shelter, etc. Unfortunately, most of them have many co-morbidities and more often than not, they take the worst care of themselves so they’re unhealthy. Some of these patients have mastered their complaints to include the buzz words that we often look for when we are trying to decide on a disposition, whether they need to stay in the hospital or go home.

I had a patient today who literally comes into the ED every two weeks. I looked up his record and there were so many visits that I had to scroll down the page to get to the end of the list. He has had work ups for everything because he has something wrong with every one of his major organs, many of which were self-induced. Though I worked him up to be discharged home, at the change of shift, he threw out some big buzz words to the new incoming resident and ended up getting admitted for chest pain…for the 10th time this year.

I understand that I cannot be bias and I have to assess every patient with no expectations, but for patients like these, I can’t help but be frustrated. They don’t take care of themselves and they definitely do not take any responsibilities for their own health. They use up so many resources. It’s a vicious cycle! Because they don’t take care of themselves and have so many problems, they end up needing more resources. I don’t know how to break this cycle. The worst part is that as an emergency physician, I am stuck between a rock and a hard place. If I don’t take a patient’s complaint seriously and end up sending someone out who dies, it’s ultimately my fault, no matter how many times they have been in the ED for the same complaint. If I keep admitting them to the hospital every time they come in, I am wasting time and resources. What do you do for these patients?

I really dislike our medical system at times. I wish we put more emphasis on preventative care and personal responsibilities, and less emphasis on malpractice. Just an observation.

August 19, 2012


Filed under: Personal Ramble — dailymedicine @ 16:40

The secret to residency. 🙂


August 10, 2012


Filed under: Personal Ramble — dailymedicine @ 21:09

For this month on trauma, I have a q3 call schedule, which means that every third day, I stay at the hospital for 28 hours to take admissions. It’s been a great month so far, much easier now that I’m a second year and  I’m more familiar with the system. With this call schedule, I feel like I am always at the hospital, which is mostly true. With my rare time off, I run errands, do laundry, go grocery shopping, and do normal people stuff. For my first two weeks, I had one day off which I didn’t even notice. I had gotten into the routine. This week, I had two days off, not consecutively, which is nothing, but I found myself completely restless. I recent read an article about how society harps on maintaining a busy schedule, and I couldn’t help but relate. My first day off, I lazed around, did errands, cooked dinner, and loved every idle minute that I had. On my second day off, I had no errands to do, no laundry to wash, no food to prepare. I laid around, read, napped, and by 1 pm, I was going stir-crazy. It was ridiculous. I had gotten used to working all the time, at least for the past three weeks, that I had no idea what to do with myself when I had the day off. I felt disconnected. It was a weird feeling. I ended up doing the only I know when I’m restless – I went to Target. This is an old habit from medical school, but whenever I feel a little out of it, I just go walk around Target. I’m so incredibly odd, I know, but it made me feel less disconnected. I look forward to having a semi-normal schedule one day.

August 7, 2012


Filed under: Daily Lowdown — dailymedicine @ 15:45

Medicine continues to surprise me daily. I recently admitted a young patient in his twenties after a severe accident while attempting some dare-devilish activity. He was comatose at the scene requiring immediate intubation (placing a tube down the trachea to help protect his airway) and was flown into our trauma center. He was unresponsive and had managed to break almost every bone in his body from his feet to his head. He had diffuse axonal brain injury and had injuries to his lungs, his abdomen, his pelvis. He was a mess. For the first week, he was in a comatose state, unresponsive to anything or anyone. Neurosurgery (brain surgeons) could not get his intracranial pressure down because his brain was swollen; Orthopedics (bone surgeons) could not operate on him because of his brain injuries; ENT (Ear, Nose, Throat surgeons) could not fix his face because of his other issues. He had twenty things that needed to be fixed, but nothing could be done because he was so unstable.

After a week or so, the Neurosurgeons talked his family about his brain injuries, setting the stage for them to expect the worst. When I came in to visit later that day, they asked me what his prognosis was, and in all honesty, I told them what I knew. From my very limited experience in the medical intensive care units, people with axonal brain injuries don’t fair well. I had never seen anyone wake up even though I’ve only had a handful of patients with this diffuse brain injury. I wanted to give them hope, but I mostly want them to be realistic. After this emotionally charged conversation, we hugged and cried, and I sat around for a while comforting them. It was tough. This kid was really young. He had a bright future, minus his dare-devil tendencies. They were ready to discuss withdrawing care.

Three days later, as I am doing my pre-rounding in the morning (where I go see all my patients on my own before we round as a whole team), from the corner of my eyes, I see his arm move. I rushed in the room, practically accosted the nurse, and told her that I thought that I saw him move. Unphased, she told me calmly that he woke up the night before! I didn’t believe what I was hearing. I gently shook him and called his name, and to my utter amazement, he opened his eyes. His nurse introduced me as one his doctors and he mouthed the word, “Hi”. He was intubated but he was able to follow all my instructions and his exam went from comatose to awake and alert.

It was so crazy. So ridiculously crazy.

Though I hate to admit it, when his family started discussing withdrawing care, I had detached myself from the patient. I have a tendency to get attached and as a defense mechanism, I tend to invest more in patients who have a good prognosis. It’s a terrible thing to do, but it’s a survival technique in medicine. I am so glad that he proved me wrong! It helped that he was young and healthy with no co-morbitities, no diabetes, no high blood pressure, no heart diseases.

It’s moments like this that I am in awe of us, of people, of our bodies, and how resilient we all are. Though extreme, it’s not uncommon that people recover with a little tender, love, and care provided by modern medicine. It’s kind of amazing.

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