First day in the ICU. Another fun game of guess what I’m thinking between me and the attending…

I began…

Me: “Dr. Scott, did you get a chance to look at Mr. Ziek’s numbers?”

Him: “I did, did you?”

Me: “Yep.”

Him: “What did you think of them?”

Me: “Well, his pulmonary artery pressures are high, his central venous pressure is high and his wedge pressure is twice normal.”

Him: “So you’re saying he’s fluid overloaded?”

Me: “Yes, that’s what I meant to say.”

Him: “What kind of fluid overloaded is he?”

Me: “huh?”

Him: “There are two kinds of fluid overload…”

Me: “Can I say right and left?”

Him: Rolls his eyes.

Me: “How about too much in, and not enough out?”

Him: Shakes his head in mock disbelief. “No. Cardiogenic and non-cardiogenic”

Me: “Oh. Well then it’s non-cardiogenic. His heart is pumping fine.”

Silence.

Him: “So what do you think of his oxygenation?”

Me: “It’s crappy.”

Silence.

Him: “See this line here where I write my diagnostic impression? If I write ‘crappy’, I don’t think I’ll get paid.”

Me: “Hmm.”

Him: “So what is it?”

Me: “Well, he’s got plenty of hemoglobin, his blood pressure is fine, and his cardiac output is adequate.”

Him: “So then you’re saying he’s got a primary pulmonary process?”

Me: “Yes, that’s what I was getting around to.”

Silence.

Me: “What about his fluids?”

Him: “Stop them.”

Me: “He’s still fluid overloaded, can I give him some Lasix?.”

Him: “Give him a small dose.”

Me: “Forty?”

Him: “A small dose.”

Me: “Twenty?”

Him: “I said a small dose. Give him ten. You can’t take it out, but we can always give more.”

Me (doubting that 10 mg of Lasix in a man who is 9 liters ahead is going to make any difference) “Well, we can always pour more fluid into him as well.”

Silence.

Me: Smile.

Him: Smile.

Silence.