Calm After the Storm

What a horrendous Memorial Day Weekend. At first, I didn't think being on call was going to be so rough and then it seemed like it would never end.

Friday night about 11pm, I went in to see a gentleman who had suffered an NSTEMI and I actually learned more about pathological Q waves on an EKG showing past infarction of "indeterminate age" and that a CPK of 250 constituted a "small heart attack."

Then 3 or 4 on Saturday am, we were called in to attend the delivery of a 31 week gestation baby. Mom's membranes had ruptured (SROM) and baby was almost 5#, but was grunting with respirations. We had the job of keeping baby stable and gaining IV access while waiting for the NICU team from Syracuse to come. This was all very fun and exciting and More knowledge was gained.

Saturday morning nap of about 2 hours lead to a dementia patient with AFIB and reportedly ventricular rates in the 150s as well as a CPK of 204. The challenge of this case was the patient was not a reliable historian and his caretaker was in denial about his dementia. She had brought him in because of increased confusion.

By Sunday sleep deprivation and the stress of being on call was getting to me. The day also brought about a case of bloody diarrhea with a patient, also a poor historian, who had an extensive cardiac history as well as surgical complications leading to sepsis in the past 6 months who was on chronic antibiotics (all of this info had to be pirated from various sources). Surgical options for cancer, bleeding diverticula or varicosities were not the best choice due to an EF of 15-20%, so doing studies to look for those sources of bleeding was not a first move. Instead, due to the antibiotic history, the thought of C. diff as well as other infectious etiologies rose to the top of the list. Of concern, he was slightly anemic and we needed to watch to make sure he didn't bleed out. Today, I learned the stool studies for infectious agents were all negative and his bloody diarrhea had resolved. So, I don't know why he had the problem.

Monday proved to find a emotionally charged case of a woman in my age group who was diagnosed with metastatic cervical cancer in the past year. She had failed radiation therapy and started chemo last week. She's a single mom with 3 small children. From her disease, she had acquired hydronephrosis and had a stent placed in one kidney a few weeks ago. She came in with increased pain in the back, leg and knee on the opposite side and studies showed hydronephrosis on that side as well as a DVT in that thigh. We started her on lood thinners and it was decided to not stent the other side as her kidney function looked normal. The bad news is that at best she has 3 years to live.

Through all of these cases and others this weekend, I learned, but it was a stormy battle to do so. Applying things I've been taught these past 2 1/2 years has not been coming natural to me and I often found myself quite frustrated because I just felt like I didn't know the answers or where to begin.

Upon reflection, I've realized this RMED experience is really pushing me to stretch beyond what I have been for the past 10 years, a lackey, to move to a higher level, that of a functioning operative. I realized that I work on my history taking skills such that I have a differential diagnosis in mind when I walk into the room from which to draw directed questions. Yes, of course intellectually, I knew this to be the course of my education, but like anything, it's hard to believe until you're there.

And though I was agitated through the weekend with my performance, with some calm introspection, I feel I learned many details and a larger lesson of accepting and exploring my path to becoming a purpose driven investigator. As I morph into this sleuth of sorts, I will also graduate into a better doctor. I'm glad to be learning this now before I have MD after my name!