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August 3, 2004 Internship Journal

The lazy days of radiology are over. I am lying in bed recovering from my first night on call. I am still trying to figure out who this doctor Lieberman guy is. I started General Medicine yesterday. I spent the morning rounding with my new team and then hurriedly trying to learn my new patients. Mary, the nurse practitioner that the hospital has provided, was extremely helpful because she has worked in this hospital for several years.

Both of my new patients have been in the hospital quite a while, Mrs. Adams since early June, and Mrs. Baker since late February, and they are both on ventilators. I once again am thankful that my physical conditioning before my accident prevented me from having to be on a ventilator, like almost all quadriplegics. Mrs. Adams has an autoimmune condition (her own body's immune system causes it for an unknown reason, just like rheumatoid arthritis or multiple sclerosis) that has affected her for several years, so when her new illness came on, she was not strong enough to fight it and she went into respiratory failure. Now, she has several issues, but most importantly to her, is her abdominal pain. Mrs. Baker is more dependent on her ventilator, and has several complex issues.

The mid-afternoon was relatively quiet. My first admission arrived at 4 p.m. The patient was coming over from our outpatient internal medicine clinic, so I kind of knew his story. It seemed relatively straightforward because he just had a facial abscess. I worked him up with Mary until 5 p.m., when she had to leave. Then one of my assistants came into help me. Just as she got there, my pager went off. The other team's needed to check out. I am on one of four general medicine teams. We all are on call every fourth night and we cover the other three teams patients. The admission would have to wait a little while. I met with the interns checking out and tried to learn their patients for which I would be responsible for in the next 14 hours.

After this, I went back to my patient. Unfortunately, most of my assistants do not have a medical background, so we have to move a little slower. I finished his history and physical and admission orders around 6:30. Now I had to find a surgeon that would come in and drain this abscess. Without a surgical intervention, his infection would never get better. I had seen a patient die from one of these because the intervention was not fast enough. I called the Ear Nose and Throat surgeon on call, but he told me that this patient needed an oral surgeon, and because there is not one in Greenville, the patient would have to be transferred for this. This did not help me because I needed someone to at least see the patient because you can not just transfer someone because you think that they need an oral surgeon. We decided to get a CT scan to see if in fact it was a tooth causing the infection. Unfortunately, it was not clear. Long story short, after a little bickering, the surgeon came in to see the patient. He did in fact have to be transferred. Luckily, there was another patient in the emergency department who needed to be transferred for the same thing. I was told that if I could have him ready in 30 minutes, my patient could ride with him. I frantically went down to radiology and got the films of his CT scan and then dictated a stat discharge summary. I looked up at the clock. It was 2:05 a.m.

While all of this was going on, my pager went off constantly. I was called to see patients that I had never seen before with low blood pressures with family members asking me why. A couple of patients of mine also had some issues. With a little handholding from the nurses and my senior resident, they were all taken care of, and I was complemented on rounds this morning for doing a good job.

After rounds, while getting my work done and trying to go home, I faced a different kind of challenge. I was almost done with my work around 1130 when I heard someone tell Mary that something was leaking from my backpack on the back of my chair. It turned out to be urine and it wasn't coming from my backpack. Somehow, my bladder had leaked. For those of you who don't know, I take a medicine to prevent my bladder from spasming, and I have to be catheterized every five to six hours. I switched medicines on Sunday because the medicine that I was taking is not in the VA formulary. It could be an infection, but Michelle and I think it was the medicine.

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