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August 7, 2004 Internship Journal

I am once again recovering from a night on call. I had an extremely busy week, but I thoroughly enjoyed it. Every Wednesday, I go to spinal cord clinic with the rehab physicians. Anywhere else, I would have had to have my own internal medicine clinic, with an attending doctor overseeing it. This is one more advantage of being at ECU. One of the patients had severe spinal stenosis (narrowing of her spinal canal, resulting in spinal cord compression and sometimes paralysis). There were two other physicians in the room, but she seemed to only speak to me as she described her gradual decline to being wheelchair-bound. She became tearful, but continued to say things to me like "well, you know." I was not able to fully connect with her because of the two rehab residents that were in the room, but she still certainly benefited from sharing her story with me because I was the only one that was able to empathize with her.

Mrs. Adams and Mrs. Baker are still in the hospital. Every morning Mrs. Adams still nods her head yes when I ask her if her belly still hurts. Since last week, we have ordered a CT and MRI of her abdomen, which somewhat explained her pain, but not fully. Luckily, morphine takes care of it, but I still feel badly that we can not fully explain it. She is moving closer to getting off of the ventilator though. Mrs. Baker has expressed to me several times that she is tired, and she can't keep doing this. I tell her that I understand, and that I too have been in the bed (of course, it is a little bit of a lie because I was never that sick or on the ventilator). She continues to ask me when she can have something to drink. She failed her swallowing evaluation, so I have to tell her that I don't know.

Last night was not too bad. I took my first admission early in the day. It was run-of-the-mill chest pain/rule out myocardial infarction. This is relatively straightforward. Patients who come to the emergency department with chest pain and a history of heart disease get admitted and get three sets of cardiac enzymes, each one being drawn every six hours. If they are negative and their EKG is negative, they go home. The interesting part of this case was that the patient had been noncompliant with his medicines. I took some time to talk to him about why. After his heart surgery, he had been sent home on several medicines that made him "feel like crap." He said that he would rather live 20 good years then 40 "feeling like crap." We were able to come to a common ground and he went home on three medicines plus an aspirin.

The rest of the late afternoon and early evening consisted of getting phone calls about patients that I had to take out my lists to see if I was even covering them. If I'm not covering them, I have gotten into the habit of asking the nurse if there is something that I can help them with. This worked well last night because most of the calls were for things like lotion for itchy skin, suppositories for constipation, and a couple of other easy things.

My final admission came in a little after midnight. It was another chest pain/rule out myocardial infarction. This patient had multiple medical problems, including a history of lying to anyone who took care of her. Last night, she told the three of us who interviewed her three different stories. These are the patients that make taking care of sincere patients difficult because they make you cynical and distrusting. It also makes taking care of them extremely difficult because when they really are sick, it is impossible to discern from their other lies. Luckily, she was well enough to leave the emergency department to go get some eggs, grits, and pancakes before she was admitted. Needless to say, her cardiac enzymes were negative and I sent her home before I left today.

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