Shittiest Day Ever

Warning: this post is not funny.

So here is a note that I started from last night, then fell asleep while I was writing it:

"i'll flesh this out tmrw when i get a chance

basically, shittiest day ever

first, arrived to get signout that one of my most stable patients had nearly coded, and was now dnr/dni on comfort measures (i later pronounced this patient dead). side note: this was the pt that said i was the only doctor he saw for 2 days. the attdg and fellow claimed to have seen him on a daily visit, per the attdg's addendums to my progress notes.

other pt nearly coding in the GI lab

other lady who is still full code but terminal"

So the first patient- the attending said he probably had a pulmonary embolism. It was sudden and unexpected, and there was really nothing anyone could have done. It was incredibly sad, I really liked the patient's family.

Anyway, the second one... got paged by a frantic nurse, telling me that a patient who should have been coming back from the GI lab was actually about to code in the GI lab, and that they needed someone from the primary team (aka ME) there. She was so flustered she couldn't even tell me what happened, and had to pass the phone off to someone else to tell me how to get to the GI lab from the heme-onc floor. When I got to the recovery room, the patient was indeed hypoxic and agitated (vomited and then aspirated post-procedure), and soon after required intubation. Transferred patient to the MICU...

..then back to the heme-onc floor where yet another elderly, frail, sick patient recovering from sepsis, with metastatic cancer was slowly becoming hypoxic and suffering while she dies. I spent maybe an hour and a half over the course of the afternoon in gatherings with the patient and her family talking about what "comfort care" means, and that it's not "giving up" on the patient but rather recognizing that she is nearing the end of her time, and helping her ease the transition and allow her to spend her time in comfort and dignity. They kept going back and forth, and ultimately (yet again at 9pm) I just had to leave the hospital and signed it out to the night float intern (who was understandably very pissed off).

Anyway when I got in today, I found out the patient had gotten a little worse overnight, they had been on the brink of taking her back to the ICU to intubate her when she decided on DNR/DNI status and comfort care.

Sigh.

Ok, no more surprises for the day... I got 2 new patients... I'm covering one of the other intern's patients too, a "stable" one that's just "hanging out" until skilled nursing facility placement... who suddenly also became hypoxic on her way to the commode to take a dump. A deadly deuce. A code on the commode. But seriously- she did become hypoxic, didn't respond to a breathing treatment, lasix, etc., and her chest xray showed (drumroll please) a....crazy pneumonia! Maybe. Some sort of nasty consolidation. Anyway, she was still tachypneic and getting tired on 100% supplemental oxygen, so once AGAIN had to call the MICU to accept a transfer.

The new Fellow covering for today called me a "black cloud." Meaning I'm bad luck and bring bad luck to the service. OR how about... heme onc is a SHITTY service? Period!

Today was another shitty day... I actually had no time to keep track of the Intern Tear Index. Default: 25+.