Monday, May 9, 2011

Monday, Monday

Well, back to the wards this morning. In a way it felt a bit like starting over after having the whole weekend off. Three of the sickest patients were gone, having died over the weekend. One was a young woman with leukemia, another with presumed PCP (an opportunistic infection frequently seen with HIV, another who was likely septic from an unknown source.
There were more patients from over the weekend to fill the beds, however. Today we rounded with our consultant - "major ward rounds" with a consultant (attending) only happen on Monday and Thursday. Dr Kamano, our consultant, is thoughtful and likes to teach, and seems more invested in the outcomes than other consultants I've worked with. The role is different here - many consultants see themselves as a teacher, and don't really see themselves as having ultimate responsibility for the patients.
Much of that responsibility falls to the registrars and especially the interns. When Dr Kamano is not around our registrar functions as team leader, running rounds and determining the plan for the day. Our intern, Shamsh, takes care of everything else - ordering labs, notes, procedures, paperwork. I'm still trying to figure out my role - I don't want to add any more to her workload. I was advised to try to follow a few patients and see what I can do to facilitate getting things done, especially on days when our team is admitting new patients, like today.
Today after rounds we had a bone marrow aspirate (done by Shamsha) and another lumbar puncture (who needs a spinal needle when you have a long IV catheter?). I noticed while we were finishing up the procedures that they were wheeling in a particularly sick looking patient onto the ward from Casualty (emergency), and she died almost immediately after being moved into her ward bed - before any of us even had a chance to see her.
The next few admissions went a little more smoothly. I admitted a young woman with anemia - a hemoglobin of 1.8 - the lowest I've ever seen. (normal is around 12) She was actually being transfused as i left, but no other labs will be back until tomorrow. I'm so used to getting labs back almost instantly that it's very odd just leaving a patient like that - but there's really nothing I can do to hurry the process along. She's fortunate to get blood so quickly - there's been a critical blood shortage and patients have been waiting days to be transfused.
Well. I feel like today's post has been more depressing sounding than today actually was. There are patients who are getting better and actually going home. They just don't make quite the impression the others do.
Tomorrow is another day on the wards - hopefully one with more answers than questions!

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