My mood was a little bit better today. I got a lot of sleep yesterday, so I was pretty wide awake most of the day. A large part of my job in the ICU (as a first year resident) involves collecting data in the morning about the patient’s overnight events, vital signs, fluids that go into and come out of a patient’s body, medicines that they’re on, all lab results and any changes in their condition overnight. If I’m really energetic and leave myself enough time, I have a chance to acutally think about all the data that I’ve collected and propose a plan for that patient’s care for the day. The more you practice thinking through all of a patient’s issues, the better you become at it, and in turn, a better doctor. There are still a lot of thinkgs I don’t know how to manage, though, so every day is a learning opportunity. If I have enough energy to learn, that is.
Both of my trauma patients from yesterday did not have any exciting events happen overnight. Bucky is still on the oscillating ventilator, but we weaned him down a little bit, which means that he may be healing inside. His lungs have stopped leaking air to the outside world through his chest tubes…that means that the holes in his lungs are healing. Hopefully tomorrow we will be able to wean him off a little bit more. MM, the nurse who hit a deer, will go back to the operating room today (OR) to have her open fractures “washed out” to help avoid infection. I spoke to MM’s sister today, who is very nice…I happened to be teh first doctor in the ICU to talk to them after she arrived from surgery. As a result, they recognize me and know who I am, which is nice. JR’s family on the other hand, interacted with many other doctors prior to his arrival in the ICU, and much of his care plan, at least in terms of getting blood products, was decided upon with the attending physicians. So they don’t really know who I am or recognize me. sometimes I just don’t have enough energy left over to be outgoing and introduce myself to families, although I’m sure from the families point of view, they would be more than happy to talk to me. I guess I’m a little hesitant sometimes because I’m frequently unsure of a patients prognosis.
We got a new trauma admission today, while I was finishing up paperwork from the morning. A older man who was trying to pass a car, and was hit head-on by a vehicle coming the opposite way. It’s amazing he survived the crash, but he broke his left arm in three or four places, his left femur, his right heel, and his pelvis. No chest tubes for him, though. As soon as he recovers from the anesthesia, he ought to come off the ventilator just fine. It also seems like most of his injuries are orthopedic…no head trauma. I don’t feel as sad when patients are likely to recover well in terms of cognitive function and their ability to interact with their families again.
A young male with end-stage testicular cancer arrived early this morning after being found unresponsive at home. Just as the family decided to withdraw care, he sat bolt-upright in bed and pulled his breathing tube out. Very odd, no one is quite sure what’s going on with him. Some of the residents here have treated him before, and the family story is a little bizzare. When he was first diagnosed with testicular cancer, he refused to have inpatient chemotherapy…insisting that he could be treated with chemotherapy at home. As a result of his refusal to come into the hospital, he did not get optimum treatment that could have helped stop the progression of his disease, or eradicate it completely. Lance Armstrong also had testicular cancer, and when I compare the two personalities and approaches to their illness, I just feel perplexed about why someone would use the excuse of not coming into the hospital to just give up completely on his chance for a cure.
I’m on call again tomorrow, and it’s a little past my bedtime. (It’s 9:30 pm) I have to get up around 4 or 4:30 am to see all my patients before rounds at 7:30 am. I like being well rested and having plenty of energy in the unit. On the other hand, I get very selfish of my free time and try to cram in all sorts of things at home in the few hours I have. I did manage to get in a short workout at the gym tonight, followed by a chocolate milk protein shake. Feeling a little sore from a workout while I’m in the hospital helps remind me of my ‘outside life’ a little bit, and makes it a little more bearable.