I walked out of the hospital today, feeling a heavy load off my shoulders.
Twice, earlier in the course of the day, I had tears welled in my eyes. For two very different reason, as well.
First, was my patient. I considered her as my responsibility because, I was the one co-ordinating the various teams. I ran the ward while my registrar was not around and down in the clinics. I spoke to the family, updating them.
After a month plus in hospital, we still couldn’t figure out the answer. I am afraid time’s running out. She was remarkably even when all the objective measurements seem to suggest otherwise. She is now in ICU on Norad to maintain her hemodynamics just 24 hours after we thought that things were looking much better. She must be septic, somewhere. But all 30+ blood/line/swap cultures had been negative! And she spiked temperatures no matter what antimicrobials she was put on. We had trials of Tazosin, Vancomycin, Meropenem, Fluconazole, Posaconazole, Caspofungin, Metronidazole treating for an assumed infection, somewhere.
The only clue we had are microabscesses in the spleen, which would be suggestive of fungal infections. She was put on antifungals with almost no effect. Was planning to go in with an U/S guided aspirate but patient was deemed too high risk for bleeding due to thrombocytopenia. Now that her cells had recovered, perhaps, we can go ahead with a guided aspirate for diagnostic purpose. Would she be fit for a splenectomy if needed, considering that she is now only 3 weeks post emergency laporotomy for perforated small bowel? Questions… questions… questions….
The second time in the day was after I walked out of the Prof’s room with his words still ringing in my ears
“You’ve done a remarkable job. I’ve got a meeting due to start 5 minutes again. So we will sit down with your registrar on Monday for a proper formal assessment. It would be a loss to our unit when you’ve moved onto another rotation.”
I think that was the highest compliment I’ve ever received. Straight from a Professor’s mouth!
Now to keep things tight for one more week.
Which is easier? Be nice or just to tell the other person to just fuck off?