Monday, March 11, 2013

Just a day at work.

It snowed hard today.There was a thin blizzard even as I walked towards the AMU.It was a monday it did not feel like one.I am walking towards a working weekend and I am looking towards it with a certain amount of anticipation and restfulness.Apparently we do the rounds for the monitered beds which is the tougher bit but that's how we learn.
Dr Samuel was post-taking today so it's like seeing someone from home.
Today I saw a patient embolising before my eyes.It was a frightening experience seeing a young gentleman in his forties going into a spasm even as his beautiful wife looked on.That was apparently the fourth time he'd had a similar episode.One big victory all of us gloat over is getting the radiologists on your side and they are a tough nut especially on night calls.For every CT/MRI requested at night you have to sell your case to the consultant radiologist on call.They call back the department and then it moves.The man had S1,Q3,T3 with RV strain pattern.We were anticipating a large embolus which would need thrombolysis.He was grossly hypoxic and mildly acidotic with a lactate which was above normal,somehow the radiologist agreed.Normally they would have asked us to give the treatment dose of clexane and then book for CT the next day.The first question the patient asked me when I told him about his condition was ,'Now I can't go for my holiday to US at the end of the year can I?
I handed the case over to my colleague one hour past my duty hour-a perfectly sweet englishman,never fails to amuse and impress me with his professionalism and sense of humour. He saw to it that I had repeated the ABG at the end of the day and yet managed to sound  so concerned that it was well past my bed-time.I could only grin in admiration.
There are so many things one needs to learn from the English.
There was another patient with GAVE syndrome who had ten co-morbidities,CKD-3,DM-2,Monoclonnal gammopathy of unknown origin,ulcerative colites with an illeostomy bag ,IHD and it just went on.....He presented with low Hb,secondary to maelena for more than seven years,he gets two transfusions every month,he had had one two weeks back....so I had to do some acrobatics there.
Then there was that 92 years old lady with AKI and AF with fast ventricular rate who had an AMT of 10/10.Had been declared unrecoverable the last time she had come in but she was sharper than most of us.She had outlived two husbands ,wore two golden wedding rings on her finger ,only her hyperkalaemia was 'oh so stubborn'.Other cases were predictable....as I walked back to my apartment at the end of the day...I was deeply satisfied...I must have lost a couple of pounds..by the way how many KGs is that?
 

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