Friday, October 26, 2007

The Sickest of the Sick

Perhaps I hadn't completely realized it before starting fellowship...but in inpatient Nephrology (that is, patients who are sick enough to be admitted to the hospital--I'm not talking about the renal patients I see in clinic, who often have normal jobs and a good life), we are often dealing with the Sickest of the Sick. That is, patients who are so ill they are often at the very cusp of life and death. Their existence is dependent upon a series of tubes, machines and carefully adjusted infusions which take the place of their organs as they are failing. Sometimes, you make a save, and the patient comes out of the ordeal okay in the end, and you feel great about your contribution as a doctor. But often, there's not much you can do and, admittedly, morning rounds can be a tad on the depressing side when the vast majority of your patients are getting worse, not better, despite your best efforts. A quick tally of my current patient census reveals that I am able to have a conversation with only 7 out of my 16 patients: the majority are hooked up to ventilators, sedated, or worse.

Before I get to experience my weekend off in all its glory, I'm on-call tonight (Friday night), officially 'til around 5 in the am. To illustrate the point I was trying to make in the above paragraph, about having to deal with the sickest of the sick, I recently got woken up by a page saying that they needed me to start emergency dialysis on a new patient who had just arrived at the hospital. Her potassium was more than 9 and the level of acid in her blood was extremely high. After a few brief words with the resident taking care of the patient in the hospital, I rapidly ascertained that this was the real deal, called my attending, and hopped in my car to drive the 20 minutes or so to Mass General Hospital in downtown Boston. Just as I was pulling into the parking lot, I got another page: the patient had just died. These are indeed the sickest of the sick. Gave me something to think about on the lonely drive home.

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