Thursday, August 24, 2006

More call

Yesterday we were on call—we had lecture from 1-5 though, so I missed the first patient my intern got and only saw the second. He is an LPN at the VA hospital I am rotating through, and was admitted to the hospital for shortness of breath and bloody cough in June. He was treated with several antibiotics, and improved within a couple days although no one was sure exactly what was going on. They let him leave with two weeks worth of antibiotics. They had taken three sputum samples from him and were going to culture them for acid fast bacteria (includes species such as the tuberculosis bacterium), but these bacteria take months to grow out. Two days ago, one of the cultures came back positive, so they called him back in and he was put into isolation. My intern and I went to the ER to see him and had to gown up and put on special masks. He didn’t have any symptoms except for worsening shortness of breath. We admitted him, and this morning the pathologists said that he does not have tuberculosis so he was able to come off of isolation.

I didn’t see my other patient (DVT and blunt affect) this morning, but he is doing fine. He wouldn’t have to be in the hospital if he was willing to give himself two shots of anticoagulant for a couple days until his oral medication kicks in, but he is afraid of needles so wasn’t willing to do that (so instead he has a constant IV, and gets four blood draws a day). We would be able to just have him come into clinic for shots, but he is living out of his truck so we couldn’t safely discharge him. He has an appointment with the VA domiciliary, so hopefully he can go there and continue treatment.

The resident let me leave today after I had done everything necessary for my patients--unfortunately I have to go back for a case conference in a couple hours, but at least I had time to get my haircut and finally get a blended coffee (different coffee shop, but this time I specifically asked if they could make "ice-blended" coffee) which was very good. My barber told me that he had just been in the VA for 8 weeks for pancreatitis--fortunately he was very happy with the care he received since it would have been a little awkward for me if he wasn't.


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