Friday, August 04, 2006

Livin' la VA loca (that was really corny, sorry)

It feels like it’s been a lot longer than three days since I last updated my blog. I am really enjoying my time at the VA now that I’ve gotten past the first two days—I always get exhausted the first two days I start anything, even something I really like, then I am fine with it. I don’t even mind getting up at 5:30 am anymore. I am still trying to figure out how I am going to fit the studying I need to do into my schedule.

I don’t remember particularly what I did Wednesday, but yesterday was my team’s on-call day. I was hoping to get a new patient, but when there hadn’t been an admit by 7:45, the resident told me to go home since there wouldn’t be time to do a full history and physical on a patient even if one came in (students are supposed to leave by ten on call days). I was a bit disappointed, since I have only done one H&P and I badly need more practice. Oh well, there’s always next week. My intern was at the hospital from 7:00am yesterday til noon today, he admitted 6 patients and covered all the patients of the other three medical teams.

This morning students had an hour lecture, so we weren’t able to pre-round on our patients. I only had one anyway though, the endocarditis patient has had a steadily rising creatinine level, showing that he is going into kidney failure. The nephrologists aren’t sure what is causing it, it may have something to do with an immune response to the infections.

Although I didn’t admit him, I am now also going to cover a chronic alcoholic who came in last night with low blood sodium and high blood sugar. He is really a mess, he has sores from lying in his own excrement for several days. Tonight I need to read about alcoholism so I will know what to do when I round on him tomorrow. His phosphate levels were also low, so the intern and I had to research (mostly by calling the pharmacy—very helpful people, pharmacists) how to treat it, then we got the order in. I had to talk to the social worker about him so that once he’s stabilized he’ll have somewhere to go (my intern, who was on call last night, left at noon so I had to make sure all his patients got the follow-ups and labs they needed, the other intern had to oversee her own patients, my intern’s patients, and the sub-intern’s patients, so I covered as much as I could of my intern’s patients, and the other student covered as much as she could of the sub-intern’s patients to help out the other intern), that was kind of weird but very neat to actually have a little bit of authority, it was like he was really my patient. Then, I had to talk to residents from consult services about my other patients which was neat since they talked to me like I was in charge of the patients (which was fine as long as the other intern was also listening, I am definitely not capable of handling that by myself). After we got all the labs and orders in, I reported to the intern on call tonight by telling him what each patient would need. I have no idea how he is going to be able to keep 20+ patients he’s never spoken to before straight, that is really amazing. Now to study…


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