Internal medicine inpatient was my very first rotation and it was at Piedmont hospital with the Kaiser practice. It has been the ONLY rotation where I worked with actually physician assistants.
I was lucky to not be there on my own I had Sara Baktiarnijad. (who knows how to spell it she told everyone just to say Bakti. although its not hard to say once you know it).
So "the Saras" as we were called walked in to our first rotation with fear and excitement. Our coats were clean and so full of pocket sized books/palms that they weighed every bit of 10lbs. And dont forget the stethoscopes around our necks. We were OFFICIAL and ready or so we thought. We made it through the first day and then they gave us our own patients to see. As the rotation progressed our coats weighed less and less. We became more confident and comfortable and eventually bored, ready to go on to the next rotation.
This rotation was one of my favorite rotations to date. I loved seeing the patients in the hospital which is also my weakness as I get attached. My favorite part was beeing able to order a lab and get it back fast and determine the next course of treatment.
There were 3 key patients during this rotation that I will remember forever.
1. Mr. Grandpa - the first day I saw him he was in full blown heart failure and his oxygen level was extremely low. He also had severe asthma and aortic stenosis. We started him on high dose diuretics and the next day he lossed 1500cc of fluid. I explained to him he lossed a liter of coke and 1/2 of another. He continued to improve although the aortic stenosis was really severe and he needed a new valve. I saw him everyday for over a week- again attachment.
2. Mrs. Pancytopenia- this lady I got 45 minutes before the end of my shift the end of the 2nd week and she remained my patient until I left. She had pancytopenia (low platelets, low white & red blood cells) but we couldnt not figure out why. I spent a lot of time researching on my one and reviewing her history. Kaiser has electronic medicial records so I can review every appt and mediciation that she has been on. I remember, every other day I would go in and say your platelets or rbc are too low and you need another transfusion. You see we would get them up via transfusions and then the levels would drop after a few days. My daily history question was if she had any new bruises.
3. Mrs. Vancomycin - this was such a lovely old lady. She had a staph infection in one of the valves of her heart that spread to the prosthetic in her knee. The first day I met her and got her history. She told me how she had this pain in her knees that seemed to go away while she was on antibiotics for the staph infection and that it returned when she stopped the antibiotics. She was back in the hospital bc she was not feeling well. I was concerned that the staph was in the prosthetic and asked my attending (Dr. Kim a really large 6'4 200 lb korean man whose eyes closed when he talked). We got the surgeon involved and it was true the infection was in her prosthetic. She needed to put on vancomycin but was allergic to it. We had to de-sensitize her to the vancomycin a new concept for me. She developed Red man syndrome which is a side effect of vancyomycin. And just like it sounds she was lobster red all over. She wished to continue and just take some benedryl. I remember going in to talk to her after the surgeon came and told her that he was going to take both legs. She was really upset and didnt like that surgeon. I dont know what happened but the plan was to remove the prosthetics and try to replace them.
well thats kaiser IMOP sorry its long but as you can tell I really liked the rotation.
sara
No comments:
Post a Comment