Hitting the ground running

7/26/07
First day on service picking up the new load of patients from David Welch, MD – a Canadian family physician who has been here for nearly a month. He had a census of 31 patients on Monday but has weaned it down a bit since that time – now it’s only 13 plus a consult. Here is the short list:
41 y.o. F with tremor, clonus, hyperreflexia, fever, weight loss – probable TB meningitis
29 y.o. HIV positive F with 3 month hx of ascending peripheral neuropathy now with profound weakness.
26 y.o. F with fever, mediastinal mass the size of a grapefruit
19 y.o. F with who had a 7.5 liter pus filled mass (Mary Weirusz started her care, and Elizabeth and I will finish it…)
55. y.o. F with HTN and out of control DM.
77. Y.o. F with end stage cor pulmonale, COPD – palliative care
26 y.o. F with HIV, malaria, Pulmonary TB, and confusion.
82 y.o. F with CHF
35 y.o. F with HIV, with an aggressively growing set of masses- breast, RUQ and R inguinal masses – 6-25 cm in size. Looks bad – bx pending
73 y.o. M with lytic bony lesions – we have no idea what they are yet – no myeloma though.
19 y.o. M with severe kyphoscoliosis – immobile, bed sores, on palliative care.
30 y.o. M with HIV, wasting, TB in lungs and candidal esophagitis
70 y.o. with huge liver with mets – biopsy pending
28 y.o. with TB, HIV – the usual


This call day I have had 5 admissions (possible 28 y.o. with malaria, and another 32 y.o female with HIV, diffuse TB in her lungs, 55 y.o. with cord compression, and 53 y.o. MVA victim with contusions, and an 88 y.o. with pneumonia), 2 other ED evals going to Ortho – acute cord compression, and an MVA victim that had occurred 5 days ago.
I hope this gets interesting…
Daniel and Jordan started working today in the supply section, getting acquainted with one of the employee's 8 year old boy who was following them all around. I am on call tonight for admissions and the ICU (which is fairly quiet). Things are running more smoothly here than in the past, more patients in the ED, in clinic and on the wards but the chaos feels less. I think the old ways of doing things are getting supplanted by newer ideas – a good thing in this environment.

Mike