Friday, February 7

medicine: wk 5, day 30

i forced myself out to the hospital. i felt miserable, but definitely better than yesterday. today, i could move. i felt a little queasy when i walked, and waves of something would come over me, and force me to stop, but still, i could move. plus, our team was on call. didn't want to abandon them.

i layered in many many layers, and braved the walk. the cold, painful walk. tempted to just turn around and go back, and call in again.

when i met my team for rounds, all asked me how i was doing. "better," i said. or rather, i croaked. i hadn't talked to any person in a while, so i was just as surprised with my voice as they were. almost to the point where i wanted to laugh. but my cervical and intercostal muscles remembered my throat pain better than i did and didn't let me laugh.

after "better," i tried to say more, but my vocal cords were somehow stuck, and no sound was coming out. coughing and hacking did the trick. also produced a nice loogie (phlegm), which i swallowed, since there was no place to spit it. they saw me hack, cough, measure, and swallow. if my whack voice wasn't enough to convince them that i was still kinda sick, this little act pushed them over.

presentation to grumpy attending also went better. perhaps because i was better prepared? (because i had spent 5 fitful, half-delirious hours last night on it) because he was warned by the chief? or perhaps he became nicer, or took pity on me. i'll give him the benefit of the doubt.

the rest of the day was a battle to quell coughs, not cough on patients, and to fight off the signs of impending fever and myalgia that i've come to recognize too well. 4 times today i thought i had lost, and was about to go home. but didn't. ended up staying until 10:30pm.

sad story:
there is a patient whose illness makes her hard to look at, hard to be around. natural instinct in anyone is repulsion. one of the docs spent a good deal of time with her. i knew her as the lady with the inflated aluminum balloon by her bedside that said, "Please God, Make My Mommy Better."

over a course of weeks, there was a gradual decline in her mental status. the team thought that it was due to an overdose of pain medications, and so backed up off them. the decline in mental status continued. she no longer was responsive to stimuli and her eyes were rolled back in her head. things were looking bad.

the next morning, she was found in a seizure. labs (perfectly normal 4 days ago) were sent to find the cause of the mystery. they came back off the roof. an absolute mystery, because such large changes would have reflected long ago in the vital signs, all which appeared to be normal in the past week.

further investigation revealed that the vitals had not been taken at all. the nurse had seen the DNR (do not resuscitate) and assumed that the pt would die soon, anyway. and thus didn't want to go through the very uncomfortable tasks required to obtain the vitals. and thus had FALSELY reported vitals. holy moly, my resident flipped out. (again, i am not bashing nurses in general. one bad nurse does not mean all nurses are bad. and likewise, one bad doc does not mean all docs are bad. (if that were true, then we'd all be really screwed, because i've met too many bad docs already))

there were mistakes on many levels:
1) started with the nurse who should have taken the vitals. and if she hadn't, she shouldn't report false vitals (medical students get KILLED if they EVER do this. they warn us of this early, early, on.)
2) sub-i should have suspected, and checked vitals personally
3) resident should have suspected, and checked vitals personally

2 & 3 are important, but jeez... if you can't trust basic data that is being reported to you, how are you supposed to function? are you supposed to check and recheck everything? if so, what is the point of having ancillary services?

everyone is feeling terrible and guilty. fact is, this woman will die soon. this is so terrible, so appalling, so ghastly.

all that keeps coming to my mind is that blank, milky, gaze in that physically disformed body and the cheerful balloon next to her:

"Please God, Make My Mommy Better."


yakob at 11:33 PM

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