A bad case of pancreatitis

Today was quite the adventure. My resident had the day off, and so I assumed it would be a quick in-and-out sort of Saturday: Round on my patients, touch base with the attendings, and then be home by noon.

Other plans were in store. I know something was amiss when I went to my 33-year-old patient's room. This was a young man who came to Texas last week with his family, trying to avoid the hurricane that hit the gulf coast. He had acute pancreatitis from alcohol use, but he seemed to be on the up-and-up so to speak. When I opened his door this morning, however, I saw his neatly made bed which was raised up high and the room was otherwise spotless. His chart was gone. Something was wrong!

When I checked back at the nursing station, the doctor on call last night told me the patient had had a run of SupraVentricularTachycardia, which essentially means his heart is beating too fast, but the electrical conduction system from the atria to the ventricles was working properly. He'd been transferred overnight to the telemetry unit and his heart slowed down with a couple medicines--adenosine and diltiazem. He was also started on a whopping antibiotic--Imipenem/Cilastatin to treat for possible infection which was suspected when he spiked a fever.

After talking with the cardiologist, I evaluated the patient, and then was intercepted by his mother in the hall. Understandably she was upset and full of questions, but the combination of the two made the encounter particularly unwieldy. I found myself trying to answer her questions and realizing she was asking the same thing all over again. The conversation ended in her frustrated and tearful exclamation, "I need to see a real doctor! Where's the chief resident?"

When it was all said and done, my patient was transferred to the ICU, where he was later intubated and put on the ventilator after his Arterial Blood Gas (ABG) showed that his muscles of respiration were fatiguing. The gastroenterologist saw him today, as did the cardiologist, the pulmonologist, surgeon, and the attending internist. I think it's safe to say we have plenty of people on board, and fortunately the patient was stable by the time I left.

Perhaps one of the most important things I did today (out of nearly eight hours at the hospital) was to spend 15 minutes visiting with the family, trying to support them and answer any question they could think of. Still, the day's work left me a little dazed with how someone--young at that--could be doing so well one day and then intubated and being managed by multiple specialists the next.