Friday, August 18, 2006


Yesterday was short call. I did an H&P on a new patient who came into the ER because he claimed to have taken four times his usual insulin dose because he was frustrated by having high blood sugars for the last week. He said that he felt confused and lightheaded. Only problem is that his blood sugar in the ER was 397 (normal 80-120), making it highly unlikely that he had actually taken insulin. He had an extensive psychiatric history of depression, borderline personality disorder, alcohol abuse, cocaine abuse, and participated in a daily program through the VA. On Monday, he claimed that the program kicked him out after two years, and he was really angry at first but now he “just didn’t care”. We consulted with psych, and what actually happened was that he skipped the participation part of the program and just showed up for lunch, so they asked him to leave for the day, but he could come back the next day. So, the most likely explanation is that he wanted attention so pretended to have overdosed himself. He’s medically stable though, so we were able to discharge him today.

My UTI patient had his Gtube put in today instead of having to wait for Monday, so we should be able to discharge him to extended care after the weekend. Oddly enough he’s been quite a bit more cooperative over the last couple of days.

My nice patient died. It was a really sad situation—yesterday he improved considerably, and we were getting ready to bring him back to the regular floor from the ICU—his family saw how much he improved and thought that he had gotten completely better, they were laughing and called us “miracle workers”, unfortunately they didn’t know how inaccurate that title is. Most likely he had a bad reaction to the plasma transfusion called TRALI that occurs in 1/5000 transfusions. I came in late to the hospital because we had lecture this morning, I looked in the computer to see his labs, and then went down to the ICU thinking he would be awake and even better than he was yesterday. When I got down, my resident and attending were writing the death note. Later in the day, we all went down to see his son and daughter-in-law who were in the room with the body. They were both crying and making comments about how they wished they could have been there, but they thought he was getting better. They immediately agreed to an autopsy, because they thought that he would want one so we could learn if there was some way we could avoid outcomes like this in the future and maybe save another patient’s life. The autopsy will be tomorrow, and my attending asked the pathologist if we could watch it. I’m not looking forward to it, but I feel like I should see the whole thing through. I never talked to him about his religion, but I saw on his chart yesterday that he had listed himself as Baptist—I hope that is true.


Post a Comment

<< Home