#11: Mesenteric Ischemia

I've been really busy at work lately. Though we've managed to get the service size down to a managable number of patients. I'm not sure if this is true or not but I think it's because I'm doing a decent job as an intern. The job of an intern is to discharge a patient once the team decides that he or she is fit for discharge. However, there are usually a number of obstacles preventing a patient from going home which include setting up appropriate home health, getting the patient's nurses to teach the patient about wound care or glucose testing, and any number of unanticipated things. Finally, just as a patient is going out the door do they realize that they want a prescription for this that or another. Once someone tells me to discharge a patient I work as hard as I can in order to make it happen because it translates into less work for me the next day because I don't have to write a daily note on the patient or put in orders if the patient has been discharged. The maximum number of patients that I've discharged is 6 in one day and I almost reached this number yesterday (I discharged 5 and had the last discharge paperwork all completed) but this one patient refused to go home even though we were doing nothing for the patient in the hospital.

My last call night left me super tired the next day. Usually around 2 or 3 AM things wind down and I'm able to grab an hour or so rest, but this night at 2 AM our patient who we suspected had mesenteric ischemia (sort of like a heart attack but affecting the small intestine and stomach instead of the heart) suddenly became symptomatic. All of a sudden she started dry heaving and feeling horrible and she was in a lot of abdominal pain, yet when I pressed on her belly it didn't cause any pain. This sort of "pain out of proportion to exam" is classic for mesenteric ischemia. I called my chief and he came in from home at 3:30 AM which really impressed me and we got labs on the patient and he and I physically pushed the patient down to Vascular Interventional Radiology so we could shoot an arteriogram (look at her mesenteric blood vessels.) The nurses and I were feeling pretty good about things because it was about 2 hours from the time the patient became symptomatic until she was on the table getting a diagnostic procedure. However, now two days later the patient is in trouble (the intervention we got her didn't work, and she's even sicker than before.) My mind is constantly trying to figure out what we should have done differently.

Last call night: Wednesday, August 9th.
Patients covered last call night: 40+, 5 post-op checks.
Amount of sleep last call night: 10 minutes.
Currently reading: Greenfield's chapter on Colon Cancer.
Currently watching: We are going to see Talladegha Nights: The Ballad of Ricky Bobby tonight.
Next call night: Sunday, August 13th.