i couldn't figure out why i was so tired at the end of every day. then the answer was given to me one evening when my sig. other said to me when i was staring blankly off into the distance, "dude you are out to lunch right now, you look emotionally exhausted" thats exactly it- people in milstein are going through so much it just takes its toll after a while.
-als patient who has to use eye movements to communicate every last thing, "itch her, thirsty, cramping, done..."
-guy who had traumatic brain injury, and is brain dead but kept alive
-guy with pulmonary issue who yells "i wanna die, i wanna die i wanna die" over and over and over (especially when we round) -he died
-woman who took previous guy's room w/CHF who can't recline past 45degrees or suffocates, "do you know what its like to want to die?", "please let me die" -she dies too
-undocumented woman w/no known family from mexico who is unresponsive and sits in mckeen for 100+ days and counting..."
-guy out of prison after 10 year stint w/drug problem and a-fib who doesn't take meds and elopes in the middle of one night despite not being able to walk >200ft without hacking
-woman w/MS with one functioning (but paretic) distal upper limb.
-woman stuck in nursing home with (choose at least one) pneumonia/sepsis/altered mental status/dementia/infected wound/vomit x10
-women w/cirrhosis and renal failure refusing dialysis for reason, "god will save me if its not my time, you doctor's don't care about anythings except money"
-women w/ severe mental retardation who is medically ok but all care is done by aging mother...
-woman (age 65, young!) w/cancer x2 and renal failure who is deaf and shivering literally falling apart
-alcoholic guy (with wife kids and other girlfriend) who drinks himself into acute pancreatitis and is demanding and entitled
the patients on our particular service average 80+ years old and are chronically sick. many of there health problems exist because of poor social situations.
i get the sense that the physician-patient relationship in inpatient medicine differs greatly compared to the outpatient setting. i put myself "in the patient's bed", like this one woman was visited by so many people one day (~20) its hard to keep track of who is doing what. consider the fact that the attendings dont spend as much time with the patients (like a few minutes in the morning x10 patients per service= less than an hour a day at best), the resident's have to rotate and cross cover so the patient never knows who's who and where's what, plus there is the cast consulting physicians, nurses, pt, ot, respiratory, speech and swallow, social worker. its a real production. this rotation has shown me that inpatient medicine is a lot like general contracting, and much of the day's work consists in lining things up for a client's project (in this case the patient's health). my conception as physician as a moral authority who sits at the bedside and chats w/patients about their children or swaps recipes and smiles and is generally happy emotionally available etc etc has been greatly challenged- a lot of "physicians" are specialty technicians, and the patient can see many "doctors" in one day. its probably because milstein is an incredibly busy place, i can't wait to try out another hospital and see how the physician/patient relationship differs.
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