After yesterday's post, I thought I should follow up to clarify that the world hasn't come to an end. Today was quite good. There was a light patient load, it went well interacting with patients and my preceptor, and we got off early. It's nice to be back on track so quickly after a bad day. It's just tough while you're in the midst of a hard experience to see past it. I'm sure I'm going to have more rough days on this rotation, but things are looking well right now (not that I like internal medicine, but the rotation is looking up). It's been a hard-learned lesson, but I truly do know that I shouldn't base important opinions and decisions on single negative experiences. Anyway, to top off the day, I just learned that I not only passed Psychiatry, but did so with honors. Some classmates and I were thinking it was impossible to get such a score on these Shelf Exams, but apparently it is possible, at least on the reputedly easy psych test.
Updating you on the patient I mentioned yesterday, he eats minimal amounts and GI (short for gastrointestinal, but can refer to gastroenterology) should have placed a PEG (percutaneous endoscopic gastrostomy) tube today to help in the administration food. A PEG tube goes through the skin directly into the stomach and is a last-ditch effort to continue using the gut to digest food when a patient isn't eating enough. Using the gut is greatly preferable to TPN (total parenteral nutrition), since the body has a lot of autoregulatory mechanisms and it's hard to get the nutrient balance just right when sustaining someone solely through an IV tube. Aside from the typical issues with having a tube in the belly, I'm worried about this patient's bed-wetting. He does not have a Foley because of the infection risk, but now he's getting an even more invasive tube in him, and his whole mid-section gets soaked with urine when he urinates. Barring a UTI, urine is sterile, but bacteria love it when they can get it, so he's turning himself into a petri dish a few times per day. His mood was a bit more positive today than yesterday, but still not back to where it was. I'm hoping he can stay positive in the long run with the long hospital stay and the recurrent procedures.
Scott
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