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August 21, 2004 Internship Journal

I finished my third week of general medicine. It is flying by. I had my two-week review earlier in the week, and I was told that I'm doing extremely well. My attending also made it a point that he was not saying that I did extremely well for someone in my situation, but that I extremely well for any intern in August.

On Tuesday, Mrs. Baker took a turn for the worse. I was called in the afternoon and told that her oxygen saturation was in the seventies (this is a percentage of oxygen in your blood stream. It should at least be above 93%, and should really be 100% for most people. In her, we are OK with 85 to 95%) and her systolic (the top number, which should be in the low 100's) blood-pressure was in the eighties. By the time that I got to her room, she was doing much better, but her oxygen had to be turned way up.

Later that night, she continued to do worse. For some unknown reason, her heart rate slowed down so much that it was in the thirties, and she stopped breathing for a few seconds. As a result of this, she was put back on the ventilator.

When I rounded on her Wednesday morning, she was notably upset. I tried to console her telling her that this was only a small step backwards, but I could not tell who I was trying to convince more, her or me. We were so close last week to getting her out of the hospital, and now she is back on the ventilator.

Spinal cord clinic was canceled this week because the doctor was out of town. I went to brain injury clinic this week instead. I really enjoy this side physical medicine and rehabilitation. The injuries can be fascinating, and in general, people with head injuries recover much more than people with spinal cord injuries. The first patient reminded me again how fortunate I was do not have suffered brain damage despite landing on my head on the concrete. He was a gentleman in his forties who had been in a car accident six years ago. His wife pushed him in his wheelchair. He was drooling on himself and kicking his left leg, the only extremity that he can move. He was somewhat able to communicate yes and no by blinking his eyes, but this is all that is left of an educated father of three.

The next patient only suffered a mild head injury, but she still had some deficits. If you met her and had a conversation with her, you would probably not know that she had a head injury. She was able to return to her work as a teacher, but she did have to change positions. Her short-term memory suffers tremendously and she quite often gets lost driving. As minor is her injury is, if I had suffered it, it is highly unlikely that I would've been able to return to medical school and become a physician.

The final patient was a teenager who suffered several injuries, including a severe brain injury as a result of a car accident involving alcohol. Fortunately for him, he is making a decent recovery both mentally and physically. He is going to try to pursue a career as a state trooper.

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