Yesterday, we had a new chief resident. She swept in and organized everything. Patient lists and defined our roles and what we can and cannot do... It was amazing! What a difference it made.
Today, we got the new interns. The senior resident always changes first so they can get a handle on what has been done so they know where to go. We have the best possible team. One black guy who really likes to teach, one OB resident who doesn't know what she's doing but is confident she can learn and help us learn, and one indian resident girl who doesn't know what she is doing but knows enough to recognize it and let us help. I am floored by the difference this made in the day.
To top it off, we were long call today, which means our team admits patients from the ER until the night team takes over. So i was chilling in the ER. We had about 4 admits. I only got to see one, but the important part wasn't even witnessing the admissions. It was having the interns, who had down time, take the time to teach us HOW to think about the case. The black intern is really good, he took me step by step through what i should do, questions i should ask, and how i should think about the answers. It's probably all stuff that other people know or figure out. But since I'm slow or something, I benefitted from being told.
Doing rounds with this new team and watching how they make decisions I suddenly understand much more about what IM at least is about. We don't have to research and understand the entire picture of the patient like i was trying to do earlier. Its more about preventing any complications and simply treating them to be stable enough to leave the hospital. You don't have to fix them, you can't even if you wanted to. You just get them stabilized enough that they can go back to their lives. That may sound harsh, but its the only way we can handle our 20 patients a day.
Let me give an example of JJ- he was my patient the second day. The one I said I couldn't finish even in 4 hours. He's an 82 y.o. african american male who was admitted because of a 66lb weight loss, unexplained. He said he didn't want to eat for the past 4 months. He gave me several reasons why over the past 4 days (because i've followed up with him) 1- he was afraid to swallow because he choked 2-because he wanted to die 3- because he couldn't swallow. Now while these seem like tiny differences and some ppl might say this discrepancy is because I asked the same question for 3 days in a row, each answer points to different causes- drastically different. Psych, cancer, and muscle spasm. The worst part is because he's so old and he's also sick with (to name a few) COPD, diabetes, hx of cancer and now has malnutrition symptoms it could be any of the three possibilities. This makes how we treat him, what tests we do, and what questions we ask change everyday (maddening, i know).
I've been following JJ for awhile now and then one day in front of the new attending he gave drastically different answers(making me look like an idiot)- which made the doc think of several more tests to run. Then there was a big hulla-bullo because his family said do the test but they aren't going to treat him for anything. So we ran the test- He has a hiatal hernia, which explains his weight loss. But the doctors weren't happy about it. Its an easy fix and would increase his quality of life. So the family doesn't show up for 2 days. But there is something else that is going on because his blood pressure keeps dropping suddenly now. We keep having to call a code purple on him-- that's get the paddles ready he's failing. And the docs are getting frustrated. Several days ago he was fine- we were sitting at his bed laughing about his son and how i had to ask him these silly questions everyday. Then the family comes back and says we never said that fix our dude! So now we're trying to fix the guy who we've let tank almost too far. Nobody knows what to think about his case now. We were going to send the guy home, but now... now we're admitting him to the ICU. He may have been a thin man before, hadn't eaten really in 4 months, but now he was near unrecognizable. The jutting cheekbones and the fact that you knew he didn't have any teeth before he opened his mouth made him look like an alien. He can now barely talk. ANd i still don't understand why he changes his story everyday or what we could have done differently.
His story makes me understand why we round everyday. IM is simply about keeping the patient alive for another day. IM isn't about cures or diagnosis. Its about staying one step ahead of the complications and of things getting worse. Which i still don't feel capable of doing-- but even though I still feel overwhelmed everyday I feel like I have a better grip on what is happening. At least for now.
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