Friday, November 30, 2007

Farewell (Temporarily) to Dialysis

Today's my last day (for the time being, at least) as the designated Dialysis Fellow. At different times of the year, I have different responsibilities. For these past two weeks I've been responsible for all the patients who get admitted to the hospital who are already on dialysis. In some ways, the service is a bit mechanical, in the sense that dialysis is a repetitive process and it doesn't take all that long to get used to ordering it.

However, in another sense, the service offers an incredible variety, too! Patients get admitted with any variety of complaints, both medical, surgical, and even psychiatric. Here's a quick rundown of the patients on my list as I left today:

1. 60ish yo male with severe vascular disease including bilateral leg amputations, just recently diagnosed with end-stage kidney disease after having an infection in his blood.

2. 70ish yo female with amyloidosis (a fascinating disease where you get deposits of protein all over your body) causing both heart and kidney failure who happens to be having some blood in her stools.

3. 30ish yo female, a diabetic who just started dialysis, who came in with a blood sugar so high that it caused her to have a seizure.

4. 80ish yo female on dialysis who keeps on getting admitted because she always accumulates fluid in her lung. We still are trying to figure out why.

5. 60ish yo male on dialysis who also has liver disease and bone marrow suppression who is having fevers while at dialysis. Again, we have no idea why. (see any patterns here?)

6. 30ish yo male, HIV+, who hadn't taken his blood pressure meds and therefore came in with all this fluid in his lungs which had to be dialyzed off.

7. 60ish yo female, diabetes, who came in with chest pain which interestingly turned out to be NOT a heart attack, but rather a pneumonia.

8. 40ish yo female with diabetes and on dialysis who has a blue painful toe which needs to be fixed surgically.

9. 60ish yo male with diabetes and on dialysis who comes in with an ingrown toenail and a nasty infection that will require a few days of iv antibiotics.

10. 50ish yo male with dialysis who comes in with weakness. Could be anything.

11. 60ish yo woman on dialysis who came in with abdominal pain. Turned out to be constipation; her CT scan showed it was packed with stool. Yum.

12. 50ish yo man with diabetes who came in to start dialysis. It was time.

13. 40ish yo woman on dialysis who had a blood clot in her fistula (the means by which one gets dialyzed) who needed a declotting procedure so as to continue dialysis.

14. 50ish yo man on dialysis with essentially the identical story as (13).

15. 50ish yo woman on dialysis who fell and broke her femur.

16. 70ish yo woman on dialysis who came in with a mild heart attack and is getting a bunch of procedures done to her coronary arteries.

I'll stop there. That's a typical day on the Dialysis Service. We're looking forward to this weekend a lot: not only do I have it off, but we are heading to PHILADELPHIA to visit some friends there. I know Sophie's looking forward to it; she's promised to be a good girl during the entire car trip there...


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