so today the doc decided she was going to give me the laptop computer with the medical record and prescription pad and set me off on my own. I felt very cool and confident. All the med assistants started making fun of me because I blurted out 'i feel like a real doctor' at lunch, which i hear i will never live down.
So the last patient of the day was particularly tough. She was a 70 y.o. african american woman and it was her birthday today. She complained of abdominal pain and diarrhea for 3 years. She claimed to have 'lung fluid' and several hospitalization for which the doctors told her 'nuthin about nuthin'. She was referred to a GI specialist and was told she had an infection but now it was gone. This is why she cannot return to the GI doctor because he was treating the infection, not the pain. And she gave me the impression it had not occurred to her to ask about her pain when the GI doctor came in. And also she has a raging yeast infection because of the pills and she doesn't want to take them again. Also she says sometimes she feels very short of breath.
So after a lengthy, confusing story on both our parts I decide to try to call the hospital and GI guy to get her records and discover she has also had a mass that was discovered and is benign but undetermined in her appendix. She was also referred to a cardiology for CHF but she was never told where to go, could not get ahold of the GI doctor who referred her and was confused by the automated phone messaging system of the cardiologist. So she just never went.
She also tells me that she needs something for her blood pressure. I take it and it is 160/98 today. So I decide we are going to put her on hctz and omeprazole. Check to make sure she has a rescue inhaler, she is not a smoker and never had asthma... strange i know. I also decide to write down the address, phone number of both the cardiologist and the pulmologist I am refering her to as well as the phone number at the clinic AND the names of her medications. That way I can feel comfortable that she is understanding things. We decide to do another BP check in 1 month and i show her the girl at the counter to make the appointment.
I go to get a drink of water and not 3 steps away, I notice she's not responding to the girl at the counter and she's staring at me. So I turn around and tap her and ask her questions to which she does not respond. Then i notice she's looking to the right and I start calling her name and trying to get her to look at me or move her eyes to the left, for which I am unsuccessful. At this point i know something is wrong. I grab a chair and sit her down only to realize she's not moving her left side. Not at all. So I pull up her arms and her left just falls. And all I can think is OMG she's having a stroke! So i tell the med assistant to call 911 and another girl to see if there are any other doctors in the house. But i know everyone else has gone home. I check the BP again and its 180/102. And I decide to check pulses, listen to her heart, which all sounds ok... maybe a bit fast.
So they tell me, all the docs have gone home and i'm the only one left. And everyone is looking at me and i'm like "well i'm not a doctor" and then i realize that despite my lack of experience... i'm it for this lady for the next 5-10 minutes until the paramedics get here. And it was CRAZY to feel that much responsiblity for my patient.
One of the MA's asks if she's faking, and i decide that's a good point. So i take off her shoes and do a babinski test on her feet. This test will tell me if her upper nerves are functioning. And she has a positive one on the left. And you can't fake that, not that I thought she was in the first place. But i covered my bases-- for the first time EVER.
It was so weird to be the one everyone was looking at. I assigned jobs to people and made all of maybe 2 decisions-- but i still totally made them! Like putting her on O2 and sitting her in a chair and NOT giving her aspirin. And it was AWESOME!!!
So the paramedics show up and everyone tells them to talk to me. And I am telling them literally everything i can remember that I know the neurologist would want to know and he isn't writing it all down! And i'm somewhat annoyed because they are going to ask, but at least I told him so maybe he'll remember. I thought briefly about asking them to take her to my hospital so I could go too and help continue her care. But then i remember its like 4:30 and we need to get her in for a CT stat and its maybe a bit selfish to ask them to drive an extra 10 minutes out of their way.
So in summary. I was a 'real' doctor today. and it was totally B.A.!!
And I wish I had more experiences (even fake ones or momentary ones where docs had my back) as a student where people are looking at me with that 'what do we do' look because man that is going to be HARD to get used to. For a brief second or two I thought, maybe i should do family med because I don't know what I'm doing... nobody should be putting me in charge of anything. But hopefully it turns out okay. I wonder if i'll ever get to know the end of this lady's story.
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