Friday, February 01, 2008

Four Of Twelve

I just spent a good 15 minutes leaning back in a La-Z-Boy staring at a popcorn ceiling thinking about precisely nothing. My wife is cuddled up on the faux leather sofa mumbling about blanket transplants.

These are the small joys of being a third year medical student.

It's nice to be home. Kindof. We've transformed this very brown apartment that the University of Washington provides for us into a semblance of home. Cut apart calenders adorn the walls, her orchids contrast with the snow outside, and my art projects sit around screaming out for explanation.

Today was our last day of inpatient call in Spokane, WA. Eight more weeks of medicine to go, but more on that later.

Today offered nice closure for me. At 1:00 I was invited to do a knee arthrocentesis. (At 12:45, I watched a video about how to do it.) After one unsuccessful poke (not deep enough), the syringe started to fill with a slightly cloudy yellow fluid. I pulled 20 cc out, disconnected the needle and proceeded to extract another 25 cc to reduce the joint space pressure and provide symptomatic relief. We then sent three vials to the lab for cell counts, Gram stains and chemistry.

A successful procedure.

But wait! There's more!

My senior resident had arranged for a rheumatologist to look at the sample. We were thinking septic arthritis (arthritis caused by infection), but had a suspicion that something else was going on. The patient didn't have a fever, both knees hurt and both wrists hurt; this is all a little strange for an infectious cause.

The thing is, the rheumatologist happened to be across town. Guess who filled the role of messenger. I've written about how medical students don't do a lot that is not duplicated. How could I forget about the vital role of urgently transporting samples? I was surprised about how important I felt walking around with a biohazard transport container. (Thinking in my head the irony of the statement, "Get this to rheumatology, STAT!")

When I found the office where the sample was to be read, it turns out that the doc was really busy and someone had totally botched up his microscope. He was having a dandy of a time getting the sample in focus. Isn't it convenient that I spent four years in a pathology research lab hunched over scopes? When I had finished preparing the wet mount, I called him over to look at something like this:

I've said it before, and while it may come off as a little pretentious, I kindof like the sound of:

What's your diagnosis, doctor?

After leaving the scope much better than I found it, I headed back to the hospital, where we promptly started dexamethasone therapy and discontinued the vancomycin he was on (His ears had started to ring).

My adventures concluded by visiting the patient to update him about what we found and how we changed his medicines. I left his room at 3:45.

This is medicine: suspicion, diagnostic procedure, microscopic laboratory examination, diagnosis, therapy decision. Hopefully the result is a patient free of pain and home for the Super Bowl.

You better believe I'll think twice before telling someone "I'm waiting for a lab result" again.

This patient agreed to my writing about him on the internet. ("After all, it's not like you're sticking me with a big needle," he said.) Also, my wife attests to the accuracy of my portrayal of our evening .

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