Thursday, November 16, 2000:
Going out to:
Another fancy drug-rep dinner. I'd rather be home.
Wondering: If I'll be able to go to the gym tonight.
In: A hurry.
LESS (morgue) FILLING
People die every day, outside of the hospital even. At least, that's what I hear.
It seems that every work entry I write, someone dies. Maybe it's because those big events motivate me to write at all. But today will be different! No one dies in this entry!
No morgue filler.
YOU CAN CALL ME BOB
I saw Mr. Bob, a kind older black man, but a bad diabetic (with a bad joke for a pseudonym), who just got his second leg amputated last week for a gangrenous leg infection. I was seeing him as a medical consultant for the surgeons -- managing his diabetes (blood sugars), antibiotics, and anything else that can't be solved with a knife and a bone saw.
I told him he may need a blood transfusion and he responded with:
"Sure thing doc. I wouldn't even be here if it wasn't for you guys. Whatever you think is best, go right ahead. I'm a little incapacitated at the moment anyways, heh heh."
Us guys have removed both of his legs so I was quite touched at his sentiment. The amputations were life-saving though. Gang Green doesn't leave enough living tissue to heal, it just kills and spreads to kill some more. So I guess we (in general) saved his life ... twice, in fact, at a big cost (to him) though.
But he thinks it's worth it, so indeed it is, I have to remind myself.
His attitude was quite refreshing and I liked him a great deal because of the reminder.
NINETY-WHAT?
The Kommandant emailed me about a new patient. A 94-year old ...
... that's all you gotta say.
I immediately thought of nursing home, urosepsis (this does not mean an infection in Paris by the way), pneumonia, flogging and futility.
When I met her though, she was completely different from the usual elderly nursing home disasters. She was quite pleasant and healthy looking, just a little hard of hearing though.
ME: "I see you have a hearing aid."
HER: "What?"
ME: "YOU HAVE A HEARING AID!!"
HER: "Yes, but it's not very good."
She became confused secondary to a bad bladder infection. After more questions, I learned she could no longer take care of herself. Blood and urine cultures. Antibiotics. Nursing home.
I thought it was amazing to be talking to someone more than three times my age. I always wonder how much a 90-year old can possibly remember or have forgotten. Are those life lessons completely lost? Are they lessons at all or just regrets?
It doesn’t matter. We’re all in such a hurry when we're young, who has time to listen? And by the time we get old enough to slow down, we've lost our hearing.
THE TOE FAIRY
Next, I saw a patient of MINE who just (hours ago) had a toe amputation and leg bypass, without MY knowledge. The last communication I had with the surgeons (written or verbal) said he wasn’t going for another three days. I caught up to him in the recovery room sans toe.
This is an example of bad behavior on the part of the surgeons, but I’ll be respectful for once and leave it at that, since most aren’t that inconsiderate.
NUMERO UNO, PUTA
JOKE FROM SOME SURGERY DOCUMENTARY:
"If you ask any surgeon who the top three surgeons they know of are, they’ll have a hard time coming up with the other two names."
THIS WON'T HURT A BIT
The toe amputation reminded me of when Amy was showing the ropes to a new nurse in the ICU (back when she still worked in the ICU). They were wrapping up a dead body (oops, I did it again!) and the new nurse went to place the toe tag on the patient.
But when the nurse lifted the sheet, the corpse’s one remaining foot was toe-less (previous amputations). I think the morbidity of it all had gotten to her and she nearly panicked,
"Oh my!! There’s no toes!! Where am I supposed to put the toe tag?!"
"Maybe you can staple it on," I answered.
Amy answered back with her Draconian *STINK* Eye of Silence, so I shut my mouth. They ended up getting more string and tying it to the one ankle.
Amy's a softy.
DON'T DRINK AND BIKE
The next consult on my list was a new one. Some guy who got involved in a bicycle versus car accident. The bicycle lost, of course.
"What was he doing on a bicycle? He’s a forty-nine year old alcoholic," the nurse asked.
"His girlfriend didn’t want to drive him there. So he rode a bicycle," the resident answered.
"No drinking and driving. Alri-i-ight," I added. I do like to amuse myself these days.
He was one of those characters who drank at least 6 to 10 beers a day. He was lucky his head was still attached, and ended up with a bleed in his brain and a concussion. He still wasn’t quite right, I learned:
"So, what’s the longest you’ve ever gone without a drink?" I asked.
"A drink? Well, the nurse just gave me some water an hour ago," he answered scratching the stapled scar on his neurosurgical-style half-shaven head.
"No, I mean alcohol. Have you ever had withdrawal seizures?"
"I don’t remember. You mean today?"
We kept him on the intravenous sedatives to give his brain a chance to adjust to his new alcohol-free blood serum. Otherwise he would have started seizing like a fish out of water, or a lush out of liquor, more accurately.
MOVE OVER ROVER,
AND LET THE REPTILE BRAIN TAKE OVERBloated, there was no other word for it.
Today her arms were seeping fluid from their pores. Her legs, her face, her eyelids, even the very whites of her eyes were swollen. You can't show people who look this bad on TV. It's a law.
She was in the surgical ICU, her belly wide open, packed with blue cloths and sealed with orange elastic.
I opened her puffy eyes and turned her head. The eyes were locked in place. They turned with the head instead of against it like the normal reflex.
The resident looked at me knowingly. Blown brain stem.
"Call the surgeons and kindly suggest they get a head C.T. Otherwise, if we order it ourselves, they’ll scoff and just cancel it. Like last time," I told him.
It wouldn’t change her management much. It just sealed her fate.
(I should add that Artemisia, an exemplary surgeon, mindfully discussed this case earlier with me on the phone, and had better suggestions than I had regarding her antibiotics. But evidently, the rest of her team didn’t listen to her either.)
HOMING GOME ... er ... GOING HOME
There were others but the highlight of the day was replaying Mr. Bob's words in my mind. I sent someone home with their grateful family members, which was good. And I damned someone else to nursing home hell, which was ... something I may pay for in due time.
Overall, today was a good day though.
Going home (any home) is still the best part, for everyone concerned.
HAPA SHINY PEOPLE
Thank you to Ben, half-Chinese (a "hapa"), who feels the opposite of how I do and explaining this to me. (No journal, but a work site).
Thank you to Queen Cyn (not a "hapa") for also "getting it" and matching my own "innocent" perviness online. See you in hell.
Thank you to Erin (no last name, no URL) for her kind thoughts as well.
Just some people I wanted to thank twice for emailing about my previous entry.
WHY I DON'T HAVE A 24 HOUR WEBCAM
(I'm resorting to Seinfeldian nose-picking gags now ... I think it's time to go.)
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