Thursday, July 28, 2011

patient encounter - incidental discovery

Mr. S is a 95 year old gentleman who rear-ended another car when he couldn't push the gas pedal far enough to stop the car. He ended up with a pretty good bruise on his right eye, a broken set of glasses, and a broken left hip. He grinned sheepishly and admitted that he probably should not have been driving. The next morning when we ask about his wife, he reports she's "running around town cleaning up all of the mess I made yesterday". He's energetic, optimistic, and is probably the healthiest 95 I've seen.

The trouble is, when we put him through the CT scanner as part of the initial evaluation, we discovered a mass in his pancreas which is likely to be cancerous. What a cruel turn of events. As we enter the room to tell him the news and discuss his options, I find myself wondering....would I want to know?

Mr. S faces the news initially with remarkable practicality. "If your treatment adds 50 years , we don't need to bother because I know I don't have that long to live. But if you can add a few years to my life, that would be something worth pursuing. I honestly love my life"

We return the next day to discuss the situation again, this time with one of our pancreatic experts. At some point, he mentions that Hospice may be an option. "Hospice. Are you familiar with hospice?" the attending asks. Five seconds pass. Slowly. Without answer. Then, "Yes".

Here we are with Mr. S, and in the course of two days he's gone from worrying about his daily errands, to wondering about some potential trouble, to preparing for the end. I wish we didn't have to tell him...

schedule

monthly rotations.
  • 2 months orthopedic surgery
  • 4 months general surgery
  • 2 months of night-float
  • 1 month of hepatobiliary
  • 1 month of icu
  • 2 months of surgery clinic
I am currently on general surgery, and will transition to orthopedic surgery next month

daily schedule (m-f)
  • 6 - 7 arrive, print the daily list of patients and review vitals and labs
  • 7:00am all residents meet for icu rounds
  • 7:30 team rounds begin (and continue really for the rest of the day). we see each patient, make sure to write a note on their chart, and place their orders for the day (diet, medications, lab tests, imaging, etc). discharge patients if ready to go home
  • 7:30 surgical cases. we are assigned surgical cases as well throughout the week. i've only been assigned a handful so far (lap chole, gastric sleeve placement, toe amputation)
weekly activities
  • m 1-3 skills lab. all interns attend (6 of us) to practice sutures, knot tying, laparoscopic skills
  • t 8-10 m&m, grand rounds. review any complicated cases, topical presentations, review journal articles
  • f 8-10 basic science lectures
weekends
  • 1 golden weekend per month (both days off)
  • round beginning at 8, hopefully leave by 2pm
call
  • 9-10 calls per month
  • day shifts 7a - 7p
  • night shifts 7p-7a
  • respond to call pager, trauma's, and new surgical patients seen in the er

Trying again

So, I thought I'd give this blog a whirl again. I can't promise that this effort won't meet the same fate as my initial attempt; but I would like to share some of what is going on during my intern year.