On Friday, 3 of the patients, who I had admitted the previous week/weeks went home. I'm seeing them in clinic this week. Was nice to see them going home, as opposed to the other type of discharge...
Today was a bit of a whirlwind. Phew. I had the usual six suspect who were still in the hospital, and had to round on them by 11. I tried to sneak through the ward and escape new consults, which didn't happen, and I picked up to more consults. Good consults though, so I didn't mind. One was a 28 year old who is newly diagnosed, admitted a week ago with pretty profound respiratory distress, and pretty impressive leg/groin/abdomen swelling. He's been there a week, and still on oxygen. The other was a patient we were asked to see for infective endocarditis, who was on a less than ideal antibiotic regimen. So, they were nice consults.
I'm on-call this week to see new consults in the surgical and ICU wards, but also get to cover the clinic on Mondays and Tuesdays, when we're in the wards. The somewhat disappointing thing about this is that, Monday and Tuesday are generally the days we get to sneak away a bit early (which still usually doesn't make up for how late we are there on Wednesdays). I got nailed in clinic, with 8 patients to see. Normal would be 2 or 3.
One of those patients was Lucky. I wrote about him a few days ago. He's the one who looked very ill, and had a CD4 count of two. I was actually glad to see him today, mainly because that meant he was still alive, and that resisting my gut feeling of admitting him 3 days ago was ok. He is still quite unwell, and this time I gave into my gut feeling and decided that I was going to admit him. The HIV medicines were making him vomit, and he looked even more dehydrated that a few days ago. But, he didn't really want to be admitted, and so I relented. Gave him a bunch of scripts and will see him (hopefully) again in a few days.
The evening finally ended when, I admitted one of the other patients who I'd sent to have labs and an xray done. Again, we teetered on admission versus sending the guy home and seeing him in clinic in the coming days, but it was 5pm, the pharmacy at the hospital is long closed by then, and there is no way for this guy to get antibiotics (aside from paying for them himself). So we admitted him, that and the one crucial lab result that we were waiting for, had seemed to go missing in the lab. Go figure.
That's about it.
Cheers
ps-I'm avoiding the obvious irony with the name Lucky. On a similar note, I was reviewing a chart for a study I am working on, and the name of this patient was Happy. He's dead.
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