Saturday, April 21, 2007

I am lost in the alternate universe that is the Veterans' Hospital Administration

Seriously. I had heard that the patient population was very different as was the nursing staff and the facility itself, but I really had not expected it to be this different. And so busy! My team has had the maximum number of patients we can carry since my first day, and they are all so sick. And have very interesting and complex personalities. Some of our patients are quite endearing - they remind me of obese, cantankerous versions of my grandpa. Others are slightly less endearing and make decisions that ensure their health will never improve. Here's a for example - one patient, let's call him "Mr. S", was admitted for an exacerbation of heart failure and a GI bleed. When you have heart failure, your heart is an inefficient pump and fluid starts to back up and accumulate everywhere - your lower legs, your belly, your lungs (making it difficult to breathe.) Edema is a vicious cycle, and the best way to eliminate it is with diuretics. So, we started diuresing Mr. S and had him scheduled for an endoscopy and a colonoscopy to determine the source of the blood in his stools. On hospital day 2, Mr. S decided that he had had enough of the hospital and was going to leave AMA (against medical advice.) His family did not support him leaving and refused to pick him up, so he stood on the side of the highway with a cardboard sign requesting a ride to his hometown. The cops picked him up and brought him back to the hospital, and his family talked him into staying and doing the scheduled tests. Before you have a colonoscopy, you have to do a bowel prep. The bowel prep involves you drinking a gallon of this stuff called GoLYTELY - which basically hyperstimulates your bowels, makes you have diarrhea and completely cleans out your colon. So, Mr. S agreed to have the endoscopy and colonoscopy, drank the gallon of GoLYTELY and cleaned out his colon only to refuse the scope while he was up in the GI suite minutes before it was going to happen. So, Mr. S was discharged home several pounds lighter but he still has a GI bleed from an unknown source. Don't get me wrong - colonoscopies are no fun and no patient should be forced into a procedure they do not want, but the prep is the worst part - seems like impaired decision making to drink all that GoLYTELY and have all that diarrhea and then refuse to be scoped. Gentle readers, if you are going to refuse your colonoscopy (probably not the best decision if you have a GI bleed), be sure to do it before the prep.

Only two weeks left on this rotation. I can make it!

In more exciting news - Raul and I are getting a dog! We have been making occasional trips to the local animal shelter to see if we might find a dog that would be a good fit for our family. Yesterday, we met a super nice black lab named Flynn and decided that he's the one. We filled out an application for adoption yesterday, and the animal shelter has a 24-hr waiting period for animal adoptions, so hopefully, we will be bringing him home sometime this afternoon. I will post pictures soon!


homeinkabul said...

Oh my! What will Greta do?

Grandma Lorrel said...

Mr. S didn't know what he was missing. He sounds like a baby to me. I've had a couple of colonoscopies and they put you out so you don't really know what's going on. At least I didn't. Don't you put the aged out before one? Men are wimps sometimes. :-)
Love, Grandma

Shannon said...

Grandma, I love you. With regard to anesthesia during colonoscopies - they do put you out in a sense. They give you this medication called versed - it makes you not really care that you're having a colonoscopy and not really remember the procedure afterwards.

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