clinician

wow i barely made it through these five days at work. too many patients, not enough staff. hardly any breaks, working well over my shift end time, it's ridiculous.. if it weren't for my patients, i wouldn't do it. but i like my job... just not the hours.

sometimes hippaa is lame, because i wish i could tell the whole story on these patient stories, instead of pieces of them, because they are amazing. and there are also ridiculous stories, and sad ones, because people are sad and ridiculous. but anyway, here is my attempt to be vague.
as i review the moments from the recent past, it's an assortment:

-crack user blew heart valves out (yah cocaine is bad for you big surprise), saw a variety of arrhythmias go by in a few minutes when he presented to walk-in clinic, and had at least 45 lbs of extra water weight on. i think he was breathing out water vapor bubbles, that's how much was in the lungs. also in renal failure, came for help too late, died that evening in the unit. oh and thank you to Charge Nurse #1 over there for stalling his admission for 4 hours because "I don't want no druggie on my floor" - you. are. a. douche. he has a family and people who care about him, and they came in right away when we called. they saw a person they once knew, not a druggie.

-felt the joy of sharing with a long time patient "heart function improved!", a miracle none of us in our office expected for this patient, "enjoy some water and salt again", enjoy your grandkids without a dim prognosis hanging over your head so much. doc said "yay betablockers & CRT", i say it is nothing we do, really, there is Someone who knows the number of our days.

-long time heart failure patient who did have a stabilized EF of 45 for a long time came in completely decompensated with signs of a stroke?! still not sure what caused the stroke but echo shows EF 10 now. two weeks later now, still no known cause of heart failure, no for sure cause of CVA, etc... brushed up on my spanish to talk with patient, will not be able to work the fields anymore (migrant worker), is still very young, will refer to transplant or mechanical heart - if he wants... doc asked "thought migrant workers didn't have rights/insurance in this country? corrected him, patient was born in the USA, just never left "little mexico" of our county, never gone to school, or learned english. parents needed him to work the fields with them.
at the end of the day after a bunch of outpatient testing, was drawing tubes and tubes of blood trying to explain what each was for.... the biggest tube is for pre-transplant antibody screenings, it's literally a tube like the size of my arm.... 'antey, bodes'? que es?" he asked . . i said, "let's just hope you don't have any of those" as the tube filled with murky red.

-filled out five disability applications for five different men, all who want to keep working, all who can't perform their job anymore due to heart failure. one of these is a laborer, and has been in denial for the four years i've known him about his limitations. he lives in a rural area, and has been shocked by his ICD over 20 times just from pushing himself at work. (ICD is an implantable defibrillator device that shocks you out of a sudden death arrhythmia. you can imagine how many times we've changed the battery.) that's right, a literal zap kick (that is so painful and will push you to the ground) in the chest over and over did not stop him from going back to work. it also doesn't stop him from driving himself into clinic when this happens instead of doing the right thing and calling 911... but anyway. now his heart is getting worse, and we've tried everything humanly possible to fight his heart failure, except transplant/mechanical... now he's short of breath, can't walk without panting, and can't lift things anymore. barely 40 years old. still have not met his wife, wondering what she thinks and if she cares? or if coming to the doctor is just too difficult? or what?!

-college girl discharged from hospital after arrhythmias resolved. doctors & nurses had grilled her there, found no drugs, no OTCs, no stress in life, no recent infections, everything great, no known cause for arrhythmias. 2 days later comes to clinic for outpatient testing. as i checked her in, had a lot in common. had the same shirt too from Old Navy. liked the same soda. had the same opinion on the blah winter weather up here. same height, same weight. asked my general screening questions before putting her on the treadmill (while watching PVCs go by ballistically on the EKG) ... "Well don't tell anyone but me and my boyfriend do meth sometimes. I think that's why i had this heart problem, but im totally not going to do it again." a few minutes later.. "oh yes, I do use diet pills, do those affect your heart??" a few questions later... "yes, i do like the Rockstar energy drinks, i'd say like, 5 a day, or 3, i dunno. sometimes a different brand."

-saw routine follow up on a 30-something heart failure patient, had normalized heart function for the past year, echo didn't even look like someone who had ever had a heart condition, really no reason to follow up with us as often, continue current meds, see us in six months... doctors very happy with patient's "healed" idiopathic heart failure. 4 days later call from the coroner, sudden cardiac death, in his yard, when out enjoying the first few rays of sunshine to come this spring. wife found, but already gone.

-severe end-stage alzheimer's patient comes to clinic for check up, which is something we rarely see, come to find out family dragged patient in. family demands fix for patient's heart problems, that that is what is causing all of patient's problems. i don't even have the energy to argue with them or even respond to their "Chief complaints". i look at the patient, almost completely vegetative, unresponsive to the world around them, and sigh. tried to find a place to take blood pressure, extremities completely contractured. not sure how the aide had dressed them in the morning - it must be quite a task. wondering to myself what kind of lift they use at the nursing home to get them in and out of the very large chair. realized i stopped listening to the family like 5 minutes ago.

-watched my mechanical heart patients walk around and around the hallway, some flirting with the nursing assistant who has them on an 02sat leash for their six minute walk test. made my heart happy, because i remember last year when they couldn't walk, or hardly breathe, or eat, or be outside the hospital. now they're at home with their families, they all had a good Christmas, they are doing Wii Fit and going for walks outside.