menometrorrhagia

This week's patient is a 27yo guy who was on service when I started the rotation, which means I took care of him but didn't admit him. He has a history of ulcerative colitis, diagnosed in 2004, for which he has had a total colectomy (his entire colon has been removed) and the construction of an ileostomy (the end of his small intestine opens out onto the skin of his abdomen), which he will have for the rest of his life. It turns out that people with inflammatory bowel disease are prone to developing disease in many other organ systems. Mr. C has had the misfortune of developing bronchiectasis and interstitial lung disease. He also had the misfortune of contracting hospital acquired pneumonia a few days before I came on service.

His GI problem had been under control for a few days but because of the pneumonia on top of his bronchiectasis he was still requiring a lot of supplemental oxygen. (The respiratory therapist kept putting him on a non-rebreather mask which was simply not necessary. This was incredibly annoying because I was trying to figure out just how much oxygen he needed to keep his sats above 90%, but everytime they dropped below 88% the RT would put him all the way back to 100% non-rebreather and I'd have to start all over.) He was on oxygen at home but instead of oxygen tanks he had an oxygen concentrator, which has a limited capacity. He said, and the RT confirmed, that his concentrator could go as high as seven liters. One morning I put him on 7L O2 by nasal cannula (after the RT lied to me about trying to wean him over night) and checked on him ever 10 to 20 minutes for four hours. His sats were always above 92%. He went home that day.

The next day he came back to the ER because of hypoxia. It turned out his concentrator only got as high as 5 liters.

The moral of the story is don't expect patients to know the details of their own healthcare. I should have called his home health agency and found out for sure what the limits of his machine were. All's well that ends well, but this should have been avoided.

*****

I feel like I'm a pretty good intern. Well, I'm pretty good except that I'm kind of slow. I mean, except that I'm kind of slow and I don't know anything. And I'm unattractive and out of shape and my daughter shuns me at every opportunity. And I'm broke. But other than that I'm a pretty badass intern.