Attending switch

Yesterday my team was on call. I spent a long time getting and writing up an H&P on a new patient, then he was transferred to Heme/Onc (cancer doctors) so my entire H&P was basically a total waste and now I don't have a new patient. Oh well. He was kind of interesting, he was an elderly man with stomach cancer that had spread to his liver. He was sent to the ER by his primary care doctor because he had a temperature of 103 degrees. He didn't feel sick and had no symptoms other than a little abdominal pain he's had for months. That morning he felt cold, so he got into his car and turned the heat up full blast then fell asleep for two hours (it was over 80 degrees outside yesterday), woke up, and could barely walk. Then he drove to his doctor's appointment.

Today we got a new attending so things were a bit disorganized as he tried to catch up on all of our patients. He does things a bit differently than our old attending which might be hard to get used to, but it should be a good learning experience to see different styles. He wanted to round this morning at seven, so I had to get there at six--I was not a happy camper this morning, especially since I didn't leave the hospital until after nine last night. Tomorrow I don't have to be there til seven though, so I should be able to manage that.

My patient with the UTI (whom I mentally refer to as "Oscar" [think Sesame Street]) should have had a tube put into his stomach for feeding purposes a long time ago since he can barely swallow and probably has pneumonia from inhaling food, but along with breathing treatments and heparin shots has refused it. Problem: he needs assisted living and they will not take him without a G tube. My intern basically told him point blank that he will either get the G tube and go to assisted living, or slowly starve to death in the hospital, so he finally agreed. I had to convince him this morning to let the nurse put in an NG tube (goes through nose into stomach) until the radiologists put the G tube in. We'll see how long he keeps it in--I'm sure I'll hear about it tomorrow morning.

My other patient, the one with ascites and pleural effusion, is not doing well at all. It looks like he has developed severe pneumonia, he had to be moved to the ICU this afternoon as his oxygen saturation went down to 70% (normal is above 97%). The resident doesn't think he has much longer.

On a lighter note, I have been looking forward for days to getting an ice-blended coffee since I have not had one for months and I seriously need sugar and caffeine these days. I had it all planned out how I would try a coffee shop I have never been to before right after lecture today, and have dreamed about the creamy, sweet, cold taste all week. So today I went there, but couldn't see anything like what I wanted (frappucino equivalent) on the menu, so I asked the guy behind the counter if they had blended coffees. When he seemed really uncertain, and mentioned he had never heard of a frappucino I should probably have seen a red flag. He pulled out the list of ingredients for their different coffees, I saw a caramel one, asked if he could make it blended, he said yes, so I said I'll have that. He proceeded to make a regular hot coffee and gave it to me. There was a line forming behind me, and he seemed really new and not very self-confident so I didn't have the heart to tell him that it was the opposite of what I wanted (this was my good deed for the month). It tasted pretty bad for a hot coffee too. I almost drove to another coffee shop I had seen, but decided that paying eight dollars in one day for one coffee was not a wise use of my money. Maybe tomorrow. Or Friday. Lesson: Don't count on worldly material things.