Two funny things happened this week. Well, not funny. Wonderful. Things that seem like milestones in their own little way, even though I’ll be the only one marking them. But they’re kinds of things I think I was hoping for when I signed up for all this in the first place.
A patient asked for me by name. This wasn’t a medicine patient. It was actually one of the people I’d been taking care of while on pediatrics. A 20 year old boy with cystic fibrosis. One of my first patients ever; I think I picked him up on my first day as a real 3rd year, back in July. As a beginning 3rd year, I didn’t really know what to do for any of my patients. Even now it’s difficult, though I’m getting better and contributing more (today was particularly good; I pointed out to my intern that we should probably start p.m. CPAP on the woman with OSA that we just took off the vent, and that we should probably start ibuprofen on our pericarditis patient (but what if he has uremia from kidney failure?)). But this story was before I’d done so much studying. At this point, I was just a vitals-taker and a medication reconciler.
CF (I’ll refer to my patient by the initials of his disease) wasn’t a difficult patient. He was just in to treat pseudomonas pneumonia or something. Probably on pip/tazo and cipro. Contact precautions, so MRSA, tx w/ vanco. Some of it I learned 2nd year. Some of it I learned from him. What I’m trying to say is that the things I had to offer him were not medical. They were the same things any 25 year old could talk to a 20 year old about. I guess the one real difference was that I knew his disease, so I could somewhat understand what he was going through, and what he was up against. And communication was easy, and we got along well, and I enjoyed having him as a patient on my peds service.
My classmate paged me a day or two ago. CF wanted to know where I was, and if I’d stop by and see him. Sure I would. And I’m right back in there. Does he have a job? Yeah, he’s been working at the community center for a few months. Has he started college? Nah, never liked school. Figures he needs some education eventually, but for now he just wants to take it easy. How’s the girlfriend? She’s fine. Working, taking classes. She’ll be in to see him later today. Her grandparents probably come too. They’re really nice.
I haven’t asked him yet if he knows that he’s sterile. The vas deferens just don’t develop. Or rather, they do, but get clogged up just like the lungs, and involute (unlike the lungs, which dilate, which is why bacteria grows so nicely in there).
CF made a movie. I’m gonna go see it tomorrow. I’ll probably ask him how the paperwork for the lung transplant is coming along. I doubt he gets approved. He’s not an ‘ideal candidate,’ I’m guessing. But I hope he does, and I’ll push for him to. He’s my patient (even if it was for less than two weeks, and this all happened 5 months ago). I think I’ll always consider him my patient. I guess this is continuity of care. So that was the first thing.
A patient thanked me for saving his life. I didn’t personally save his life, but I was involved in the process. I know DKA when I see it. Nausea, vomiting, polyuria, polydypsia, ALOC. Anion gap acidosis, hyperkalemia, hyponatremia. Classic presentation. Fluids (we gave him 13 liters the first day), insulin drip (0.1 U/kg IV. blood sugars were initially 1670!), remember to add some D5 and potassium as things start to correct. Not too fast, don’t want him to herniate his brainstem. No problem. But wait. 52 year old, previously healthy individuals don’t get insulin dependent diabetes just like that. What else could be wrong? Maybe this guy has pancreatitis. Get a CT, amylase, lipase. Aha, so that’s it. Calculate Ranson’s. Amazingly, he’ll probably be fine. And today he was. We’re advancing his diet currently. No, I didn’t order any of this stuff. But I knew what to do. My senior asked what I would do, and I knew. Blow for blow, turn for turn. And it was right. My plan would have corrected this guy’s problem. And he’s getting better, and we’re just monitoring to see his pancreatitis doesn’t have further complications. And he thanked me. He said to me, “Thank you for saving my life.” And his brother said, “thank you for saving my brother’s life.” And I know I didn’t. I know it was the senior who ordered it, and the nurse who placed the bags, and the scientists who studied hormones like insulin, and the physicists who figured out how to make 3D images the human body with ionizing radiation, and the pharmaceutical companies who learned how to synthesize the stuff, and the clinicians with their placebo controlled randomized prospective trials. But still, a small part of me feels like I finally did something that mattered to someone else. And I try not to get all worked up over feelings, but this is kinda new and wonderful. So that was the second thing.
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