N.B. This CXR of ARDS is from Wikipedia - so no I did not steal the film from work. Have more faith than that people!One of the cases today was of a patient who had sudden unexplained seizures, was subsequently brought to hospital where they developed aspiration pneumonitis. Now they are in our hospital where they have:
1) ARDS
2) Kidney/liver problems
3) Major thrombocytopenia (i.e. platelets - the stuff that helps clot your blood - was in the 20s to 30s, normal is ~140)
4) what they think is SIRS.
5) Is on so much vasopressors (meds that constrict your blood vessels so that your blood pressure doesn't fall to low, & blood to vital organs, e.g. heart, brain, is maintained) that their fingers & toes are actually blue, to the point they look black (I know because the nurse showed us)
In other words, they're pretty darn sick. And to top it all off, they have NO IDEA what is going on with this patient. What is the underlying cause? Could it be sepsis, suggested Dr. Charming? Unlikely, said Dr. WalkingEncyclopedia. They've been on broad-spectrum antibiotics for too long. Maybe TTP, said Dr. Nice (who btw is the only female attending, why are there so few of us??). No, because there were no RBC fragments on the blood smear. Hypertension?? Ischemic hepatitis?? Alveolar hemorrhage?? No clear answers.
This all led to a heated "discussion" between Dr. Charming & Dr. WalkingEncyclopedia (again?!?! I tell you this is a weekly thing) which was highly entertaining (imagine your head going back and forth like Pong but 100x faster, as they fire "constructive criticisms" at each other) but got sort of confusing because they started using all these terms & abbreviations that I recognize but need more time to be able to register in my head. I can't think that fast guys!
So unfortunately everything is just a mystery right now. Fascinating stuff, but tragic at the same time. But at the same time, these "discussions" between the two docs definitely add to the entertainment value. It's pretty funny because you'll know when Dr. WalkingEncyclopedia is really...uh...peeved by Dr.C. It's when he starts calling Dr. C by his full first name. Like Charmingson, not just the nickname Charms. Almost like he's a kid who's in trouble with his dad (probably doesn't help that Dr. C says 'dude' a lot, even during rounds, and sits on TOP of the chair back, tipping it back & forth). But honestly I think that most of these 'talks' are in good fun, and that they actually really like/respect each other. They just have a hard time expressing it. Like a real family!
My thoughts on the whole thing? The only thing I can say is that I hope in 12 years time, those same words and sentences that were coming out of their mouths will be able to flow out of mine as easily.
P.S:
Dr. Charming to Stuff
(who was wearing a particularly colourful pair of rainboots today - Truffles you know the ones)
"Nice boots"
Stuff
[swoons]
(who was wearing a particularly colourful pair of rainboots today - Truffles you know the ones)
"Nice boots"
Stuff
[swoons]
3 comments:
wow, your rounds are SOOOOOO awesome!!! clinics on my side are just basically "and this guy had a table saw injury, and this guy had a motorcycle accident, this one here is another tablesaw injury, another tablesaw injury, and... oh, I think this one's something different.... nope, it's another tablesaw injury..."
LOL! it's now officially undeniable that you know how to work those rainboots =P
sadly, they're only once a week... i wish it was everyday. Post about your clinics/work too!! Inquiring minds, aka me, wants to know!
As for the boots, I don't know if he was admiring them, or laughing at them... most likely the latter, since when I was going home, I got lots of weird glares from many, many people. Plus my mother said that I looked like a 'cute' farmer...sigh...unfortunately, I think the cute was added b/c I am her daughter.
Hilarious, the ping pong battle between Charming and Encyclopedia... and the boots, heh, were you love-struck the rest of the day after that?
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