My first call: Rounds the next morning

Seeing the patients went smoothly and was easier than two days before when the patients were new to me. I notice how much more confident and comprehensive I felt on the patient’s I’d admitted. One of my first orders of business was to check on my patient with the dropping hematocrit. His next lab draw showed a further decrease in Hct, so I called the daughter’s home again. A granddaughter answered and gave me her mother’s vacation home number. I reached the daughter finally, explained the situation, and got telephone consent. A nurse listened in and co-signed the consent paperwork. At last! I could finally write the orders, “1. Transfuse 2 units Packed Red Blood Cells. 2. Premedicate with Benadryl 25mg PO and Tylenol 650 mg PO.” The premedication prevents minor allergic and pyrogenic reactions.

Then there was my patient who’d had a stroke. One week before admission, she’d been functional, able to care for herself, cook for herself, etc. This Asian woman had had a stroke in her cerebellum which affected her ability to walk and her coordination. Not so bad, really, considering what could have happened. My impression is that on the day of discharge (July 1st), she was still able to walk with a walker, and was totally lucid. She had perhaps a little difficulty with using her left arm. And she was not anticoagulated since the stroke had converted to a hemorrhagic one. But then the night prior to admission, she’d fallen in the bathroom while her daughter was trying to assist her. It was more of a slump than a slip. She’d bumped hit her head on the tile wall. The daughter walked her back to bed, but then noted some hours later that her mother was disoriented, not responsive, and staring constantly to the left. At this point they brought her in to the hospital, one day after she’d left. She would mumble some unintelligible words, and could barely move her extremities.

While making my rounds, I walked into a room full of people. Daughters, sons-in-law, granddaughter…all had come to be with this matriarch. And with tearful, expectant eyes, they looked up at me (one month into officially being a doctor and two days into my new job) and began pouring out their questions in broken English. “What happened?” “What does the MRI test show?” “Will she get better?” “Did her fall do this?”

The last question was the biggest challenge. Even though I wondered if there was some possibility that minor trauma could lead to an embolus coming loose and causing an ischemic stroke, I thought in the elderly a bump to the head would more likely result in a subdural hemorrhage or something of the sort. More importantly, I realized that the patient’s daughter was in a position to blame herself for her split second of inattention during which her mother fell. Even though it may have been technically correct to say, “Will you please wait a minute while I go look that up?” or “Why don’t you ask the neurologist when he comes by?”, I believed, and still believe, that at that moment it was more important for me to go out on a limb. I’ve had four years of medical school for a reason, and I think that gives me some grounding for spontaneous answers that I can’t back up right away with statistics and figures. In this case, my role was not statistician but healer. I looked the daughter in the eye, and slowly, such that she could understand in her limited English, I told her, “No. I don’t believe the fall caused your mother to have a stroke. There was nothing that could have prevented that stroke. I know you hate to see your mother this way, but I can tell you she is one fortunate woman to be surrounded by all this family that loves her.”

Rounding next brought me to my elderly patient with the UTI and suspicious cardiac enzymes. The nurse met me at the nursing station.
“Doctor, are you taking care of Mrs. C?”
“Yes, I am.”
“Could you do something? She’s really agitated!”
I paced over to her room, hearing noise through the door. Upon opening it a sight met my eyes. There, attempting to restrain a feisty, naked, and agitated 92-year-old were a nurse and an assistant. “I’ll write some orders,” I said, turning on my heels.
“Make it intra-muscular!” I heard behind me. “She’s pulled out her I.V.!” This time, it was “Haldol 2mg IM” I wrote in her chart. Multiple shifts in the psych ER proved beneficial in this case. I reviewed the patient’s vital signs and nursing notes at the nursing station, and ten minutes later, she was lying clothed and tucked into bed, peaceful and cooperative when I went in to see her!