Wednesday, May 13, 2015

Day 1: First Impressions

For the next month-ish I'm observing rounds in a Cleveland-area hospital. More on how I got here later, for now here are some of my first impressions

From my notebook while I was waiting for the MICU (Medical Intensive Care Unit) rounds to start.

People look tired but are friendly with each other. A janitor sees me sitting by myself in the atrium. "They didn't forget about you did they?"  The visitors badge combined with my nervous fidgeting must be more obvious than I'd hoped.

8:15-noon MICU Rounds
I've always had a lot of respect for doctors but observing the MICU doctors took my respect to another level. As a patient you might think your doctors barely know your name. In fact, they know every minute medical fact about you. They know your medical history. In many cases they know your family's medical history. For every chemical, endogenous or foreign, they know the concentration in your body. If you've been in the hospital for a while they know the whole history of every chemical's concentration in your body. They know what each chemical concentration might indicate about your health. They know a bunch of stuff about you that was too fancy for me to follow or remember. The amount of health-relevant data they have on you is staggering. And like I said, it's not just that they have so much data it's that they interpret and analyze all of it.

Of note: Most of the patients in MICU were alcoholics and/or smokers whose bodies eventually couldn't keep up. Most end up with partial organ failure and chronic infections all at once. If you're a hard drinker or smoker, please stop. The future isn't bright.

1:20pm-5pm Psychiatry Consult Liaison
When patients get admitted into emergency and there are obvious or probable reasons for psychiatric evaluations, these doctors are called in to do just that. For example, if someone suffered an injury that looks like a suicide attempt or someone is delusional or even extremely depressed the psychiatry evaluation team is called in.

To me this was by far the most interesting part from the point of view of medical ethics. Based on the psych evaluation, the patient can be forced to stay in the hospital. For example, if they're perceived as a suicide risk.

I filled half a notebook on my thoughts and experiences doing this round but I'm going to limit this entry to just one anecdote.

As an official observer--unless asked for my opinion--I'm expected to do just and only that: observe. But this isn't always easy.

One person I saw was extremely depressed. They (I'm intentionally using an ambiguous pronoun) were in their later years but still living independently---even working.  They had recently beaten what is for many a terminal illness. They had mustered the strength to get through the treatment. Quite a feat for anyone. They got their life back. They fought for their life back. They were exercising again and even working. Life was looking up.

During the post-treatment there was a complication and their organs failed. Now there is nothing that can be done. All that fighting for nothing. They explained to the doctor what had happened. "Do you want to live?" asked the doctor. "Not like this...not like this. I'm independent and I took care of others and now I can't even take care of myself".  The patient began to cry. I wanted to comfort the patient and hold their hand but all I could do was observe.

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