Thursday, June 10, 2004

Today was one of those days that just when I though I was about to get out of the hospital, I got sucked right back in. The resident/staff service can do that to you. Just a few of the poor souls who have crossed my path over the past week:

60-ish woman with several month h/o weight loss, abdominal pain, and right lower quadrant mass. Has a cecal cancer with liver mets. Her resection was actually easier than I thought it would be, given the size of the mass was 10 x 10 x 8 cm.

Late 20's with a chromosomal abnormality, chronic pancreatitis, gastroparesis, recurrent DVT/PE and a enterocutaneous fistula. The fistula is from a jejunostomy tube site which was brought out through the main incision (not through a separate incision). He is status-post a pancreatico-jejunostomy, gastric pacemaker and the above feeding jejunostomy, all done at big academic centers in a galaxy far far away. Because of insurance denials and the big centers cutting their losses, they have sort of inherited me. I've placed a caval filter and a few long-term lines in him. He was in the hospital a few months ago with a line infection. The tunneled line was removed and a temporary triple lumen was placed. Against my advice his primary care team sent him home with it, and inevitably he came back with a line infection. His mother works in the hospital and tends to dictate his care. I replaced the line and obtained a duplex which showed DVT in his right IJ and bilateral subclavian veins. Again, to my chagrin, he was sent home with the triple lumen as his access AGAIN!! He comes in my office and we schedule his long-term catheter. We find he has no suitable conduit between his left IJ and his cava. He and his family are adamant, almost to the point of being pathologic, about not having a groin line. He will probably become an "access death". He will either die from a lack of access, or die while having one placed.

Three teenagers in an auto versus tree collision. Driver with right pneumo, bilteral open femur fractures, and the worst-looking open tib-fib fracture I've seen. Front-seat passenger with intercerebreal contusion, splenic and left renal laceration, and a small bowel injury. Backseat passenger with humerus fracture.

I did finally get out to get my boys to the barbershop for long-overdue haircut.
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