Wednesday, November 19, 2008

Telemetry Room Review

The first room had a post-coronary-bypass patient. Pacer wires to come out later, along with his drains; up walking and talking.

The next room had a patient who came in with the sniffles. During a bronchoscopy she developed a pneumothorax and there was an air leak evident in her chest tube drainage system. She was seriously pissed off about that, but otherwise doing okay. Room air saturation 94% and up and about.

The guy in the next room died. He had said he was going to. Decades of non-compliance; he didn't check his blood sugars, nor watch his diet, and he drank and smoked all his life, so his diabetes finally killed off his kidneys. The dialysis room had called for him to go over there at 0700. When I told them that he'd passed away in the night, they said, "That's too bad. We'll take the patient in room 12 then."

Yes. Just like that.

Next door down was a chronic alcoholic with ascites. His scrotum was so swollen that it has swallowed up his penis and when he urinated it just dribbled all over. We weren't doing much for him so he'd be leaving later, which was good because he was a miserable human being whose only pleasure left in life seemed to be making other people miserable, too.

There was a post-Nissan-fundoplasty patient next. Doing well and going home soon. They were also schizophrenic. Such patients are often the best-behaved of the bunch. He never complained, but he never smiled.

Then next, a twenty-five year-old with back pain and constant demands for more and more opiates. He'd nod off with his eyes rolled up into his head. Then he'd wake up momentarily, just long enough to loudly demand that we call the doctors to get his meds increased. Then he'd pass out again, saving his nurse from having to make yet another stupid phone call.

The guy in the next room had been drinking and taking sleeping pills. He fell and broke his arm. Naturally that required telemetry monitoring. He had been discharged to a skilled nursing facility but refused to go, and his family members refused to take him home.

There was another alcoholic in the next room. He likes to drink on the tailgate of his truck. Actually, he likes to drink and then fall off his truck, having been previously admitted for this. He had failed two swallowing studies, which would seriously impinge upon his future alcohol consumption. We were feeding him through a Dobhoff tube, which gave him loose stools so he had a rectal tube also. In one way, out the other.

The guy in the next room was on his sixth admission (at our hospital) this year; there'd also been others at various healthcare outposts around the valley. He always has chest pain unrelieved by nitroglycerin; instead, larger-than-usual amounts of morphine are required due to his heroin habit. Negative enzymes, no ECG changes, negative stress tests, every time. When he found out he was discharged he suddenly developed crushing chest pain. After getting "his" morphine he went out to the curb to smoke. That seriously ticked off the lead resident, who confronted him when he got back to the floor. I thought the doctor was going to help the guy pack his things and toss him out himself. The patient promised us we'd be hearing from his lawyers; apparently one of many. Junkies with lawyers.

And so on and so forth.


Kathy throwing her $2 in. said...

I am somewhat depressed now.

Amy said...

Just when I was starting to think I might be missing clinical practice...
Thanks for the reality check.