Sunday, September 26, 2004

Shock the Crap Out Of'em

Three days left in my CCU. Yesterday was my only day off per week. They do this so that we don’t have any more incidents where residents jump off the roof of the hospital to their death. I am pretty confident that had there been no casualties we would still be working 24/7. They tell us it’s better for our education to work the long hours. “Care continuity” is the magic word around here and every time us residents hear it we begin to feel our peristaltic waves changing direction as the food slowly makes it’s way up our esophagus.
There are fresh new faces here and more tragic stories. A Few Updates, Ms. R with the widow maker is doing quite well and maybe, contrary to our medical opinion, she may actually one day make it out of this hospital. “Paranoid deluxe” went upstairs to torment another resident who will undoubtedly attempt to take his own history. “Dah” is still here and heading downhill, his kidneys, after realizing that his cerebral cortex had royally screwed up, have decided to shut down for a while as they mourn the passing of normal cardiac function. He started dialysis yesterday and all of us are waiting for his kidneys to recover from their loss and get back to work.
Mr. C is new, he is a poor soul who ran into an overzealous EMT responder who decided to shock him three times so that his heart would come back to life. It did, and now Mr. C is intubated in my CCU with practically no brain function (there was no oxygen going to his brain for a long time). He has absolutely no medical chance of recovery and now can depend on a life hooked up to a machine that will help him breath when all he wants is to stop breathing. The intern who saw him overnight decided to place an external defibrillator on his abdomen just in case he codes again. We were all very happy to know that if Mr. C codes he we would send enough voltage through his bowels that we would shock the crap out of him (literally!). At least he would die on an empty stomach.
As medical management I recommend no more medical management. We should let him go to the BUS peacefully but instead we will treat every single abnormality we can and prevent him from doing just that. Welcome to the world of legal medicine. As my favorite teacher used to say "currently we are rearranging the deck chairs on the titanic”!
At least, he won't need any stool softeners.

Question to Readership: I started this blog to convey the general experience we face as residents in a city hospital/any hospital. I am unsure if you would like me to include my patients or the medicine involved in these discussions. What are your opinions? Comment or email me, I would love to hear from you.