Everyone's tucked in

This call night hasn't been so bad, except for the 10 pages I received in the span of 3 hours, most of which demanded I either see the patient or at least drop a quick note. A sampling of a few of them:

• The cross-cover patient with a hemoglobin of 4 who got a transfusion reaction when we tried to transfuse her. (I made a call to the attending hematologist on that one!)
• Irate family
• A demented patient who wanted a sip of water, wanted to hold my hand, didn't want me to leave!
• The cross-cover patient who should have been discharged since his stress test was negative, but fell through the cracks for several hours!

But lastly, there was the cross cover patient with a short run of a nonsustained ventricular tachycardia. We usually see this rhythm in patients with sick hearts (notably after a heart attack or with severe congestive heart failure), or with electrolyte abnormalities. I ordered a chemistry panel on this elderly gentleman who, though clear and lucid, was quite content to lie on his bed totally naked from the waist down. I think it weirded out the nurses.

Anyway, I wanted to make sure that he was asymptomatic during his arrhythmia. He was, but he was concerned about the Congestive Heart Failure Information Packet left at his bedside. "Do I really have CHF?" he asked. "Why didn't someone tell me, instead of just leaving this packet?"

I went out to the hall and checked his chart. An echocardiogram had been done that afternoon which showed he had severe congestive heart failure. I went back in, and apologized, telling him usually a doctor would have sat down with him to discuss the diagnosis. I didn't know why the primary team hadn't better communicated with him.

Later, as I was talking to the nurse, I found out that everyone on that telemetry floor receives a CHF Info Packet, whether or not they have CHF! This patient was handed one indiscriminately, but it was reading material he needed in the end!

I think all loose ends are tied up for the night, all the cross cover patients are taken care of, and it's time for me to get a little sleep before the next admit or code!

n.b.: The picture above is a representative patient who is surprised to hear that she too has CHF.