Admitting night

I went into the hospital at 4 pm expecting there to be few admissions at this time and planning to leave and come back at 8. Of course that is not what happened. I got there and only my intern was there (none of the other 7 med students) and we had 9 new patients! So I clerked 4 and didn’t leave til 9 and didn’t get any dinner :/ But admitting patients is fun! Except that the Kenyan med students end up just repeating what I did (and often with better information because they actually speak Kiswahili) and they are the ones to present them on rounds. My role has basically become helping the intern and resident, especially the resident because she seems to think I know what I’m talking about. Which is very questionable. This role is actually pretty fun because they ask me a bunch of questions and I get to actually make a lot of management decisions.

What was not fun about tonight was the 3 different guys who aggressively hit on me. They were each relatives of patients. As it turns out, evenings are when there are a ton of family members around the wards. I have been sort been hit on in a hospital setting before in the States but I have certainly never had relatives of my patients ask for my number… so that was interesting.

Now on to the patients:

40 yo male with ESRD from HIV nephropathy who presents with 3 days of difficulty breathing, chest pain, and cough. He had the most awful sounding lungs I’ve ever heard. Basically the lower 2/3 of his lungs sounded like there was no air but just pure junk. And he was sat’ing 73% on 15 liters of 02.

I have another patient who was newly diagnosed with HIV who also came in with respiratory distress, but with much better sounding lungs. He could have PCP or pulmonary TB, or immune reconstitution syndrome, which is something I have yet to see. His sister was there and spoke really good English and was the first relative of a patient I’ve had who acted like the relatives I’ve seen at home. Meaning that she asked me a bunch of hard questions, tried to get me to move the patient to a single bed (doesn’t exist), and was just generally very vocal about getting him care and making sure we were on top of things. The only other relative interaction I’ve seen like this was young guy today who was asking me a bunch of hard questions about his brother who is being treated for alcohol withdrawal and may have an underlying psychotic disorder – however, he was speaking very close to me and would not let me do my other work and ended the conversation by asking for my number. So I don’t think his intentions were purely to fight for the rights of his brother…

One frustrating thing that kept happening to me was my intern would tell me to go clerk a patient and I would see them and they wouldn’t speak great English and so I would struggle through the interview with the help of some relatives and then the intern would ask for the whole story from me. Then he would go see the patient and get either an entirely different story or at least new crucial pieces of the story, and make the work I did fairly pointless. Like this guy tonight who I correctly determined was in hypertensive urgency with possible AKI, but the part he failed to mention was the seizure he had last night. Great.

As an aside, I had another patient die yesterday. This was a 67 yo man who had type 2 diabetes and hypertension and came in with general weakness and inability to talk or walk for a week. His vitals were: BP 80/60, temp 38.2, RR 48, PR 145, SpO2 85%. He needed an ICU. And I fought to get him there as best I could. He had severe sepsis (likely from pneumonia) and we can’t really tell if he was in shock because in reality you can’t aggressive hydrate someone enough here on the general wards to be able to tell if they are respond adequately. However, he was clearly sick, sick, sick. But other people kept taking his BP (with automatic cuffs or by just looking at the BP tick mark thing and not actually listening) and getting higher numbers. I was basically like, regardless, the fact that this guy is tachycardic to 145 for 3 days means something is clearly wrong! But the ICU and step down wouldn’t take him and so he passed away yesterday evening. Ugh.