Friday, August 26, 2005

The wonderful world of dictation

My new favorate activity? ...dictating discharge summaries.

Nurse Practitioner F. took us down to the dictating room on the second floor and tought us how to use the system. There's a small study-like room with 3 cubicles, each with a telephone. Over the phone, we dictate a summary of the patients latest stay into an answering machine, which is later transcribed and entered into the chart. The wonderful thing about it for me is that I can spend 30 minutes with the phone and the chart and review all the important information we learned about a patient. Information that I likely missed (or forgot) in the week or so that the patient was in the hospital.

Like all new toys, I know that my enthusiasm for the activity will probably fade; I've never met a doctor who sounds excited about his dictations. But for now I'm going to let my mind wrap itself around the wonderful world of dictating. What's more, Nurse F has a whole shelf of patients she hasn't gotten around to dictating. If I go through them all and catch her up, I think it just might be helpful when it comes time to asking for letters of recommendation... ;)

Thursday, August 25, 2005

Lessons from a renal patient

"I twy to sh--, ba aw I do iss fah fah fah" said Mr. P when I asked him about his bowel movements while in the hospital. His medications, his urine toxicity, and having his dentures out, all make his speech almost incomprehensible, but he still tries as hard as he can.

We all feel for him, he came in with a complaint of 2+ months of difficulty urinating, probably expecting to get an antibiotic and go home. When the ER doc suspected a stone, he did an ultrasound. It showed a large mass in the bladder, encompassing the ureters, which is what had been causing his symptoms. He has lost 30+ lbs in the last couple months, and his urine output is now reduced and red with blood and transitional cells. We haven't done a biopsy yet, but all indications point to bladder cancer.

We attempted percutanious nephrostomies twice, trying to restore flow past the obstruction, with no success. With his renal function getting worse every day, we've decided to transfer him to New Orleans, where they have a much larger caseload of this type. While we're waiting for a bed, we'll give him dialysis to "polish him up."

Despite his condition, Mr. P has been quite pleasant to work with. I've learned a lot from him. Following the case has given me a window from which to learn renal disorders, but, more importantly, has affected me on a personal level. His prognosis may be poor, but treating him and giving him the best care we can is making life better not just for him, but for us as well.

Wednesday, August 10, 2005

that nagging feeling

One of the signs that we're growing up is when we start to see the other side of an argument. It develops as that nagging feeling, the feeling that our competetor's view, the one against which we were moments ago so determinedly opposed, might contain a grain of truth.

In my youth, this realization was largely absent. The childhood I remember was largely black and white. I seem to have felt as if, by special gift of providence, I was fated to be born into circumstances which endowed me with an enlightened perspective. Friends at school who went head-to-head against me and the values of my family had simply missed the boat; parents, when they confonted me on the values of my youth, just didn't get it; and brothers and sisters can be just plain wrong.

But then, gradually, almost imperceptably, they all started to gain ground on me. They began to haunt me as I laid in bed at night, replaying the days events in my head. I certainly didn't wake up one morning and admit that, in a given set of arguments, I was wrong. Early on, the arguments bothered me more than they used to. Boisterous youthful exchanges turned more painful and labored. Soon (as behaviorally conditioned creatures always do), I found myself avoiding the painful stimulus altogether.

Perhaps we never really stop arguing our point, but for me it's become less frequent, and more muted. That didn't do me much good today though, as the ugly head of confrontation reared it's ugly head. But perhaps I can take consolation in a trend away from that nagging feeling of adolescence.