The last week of residency for most of my class were electives with little responsibility. Their days were filled with fretting over moving or the exciting prospect of working for themselves and drawing a big paycheck. My last week of residency was time intensive... inpatient medicine, but I wasn't providing health care. My wife had suffered a long time with abdominal pain. It had a mind of its own, it didn't fit any clinical picture. Nothing made it better or worse. She seemed to be a medical mystery. Since her father had ulcerative colitis we thought we should get her checked for this serious disease, largely to put her mind at ease. This was more than a year ago and the colonoscopy wasn't quite normal, but the GI doc didn't quite know what to make of it... "it could be Crohn's? but I don't know." We tried treatments for Crohn's but it didn't seem to do much if anything. There were many a moment in which my sweet wife wondered if she was just going crazy, every test seemed to always be normal. Occasionally the pain would become horrifically intense so that there were no other options but to seek care in the ER. Over the past year she has had two colonoscopies (the second one said she didn't have Crohn's), one EGD, three ultrasounds, a CT scan, many lab tests, many doctor visits, and 3 ER visits. The last ER visit we sought admission to expidite the work up as the pain had become almost constant and she could not function in life, and couldn't even function being at home. She was losing weight now from poor appetite from the pain and nausea. The very last test that was available was the HIDA scan (a functional test of the gallbladder). It was quite abnormal.
The surgeon said, 80-90% chance that surgery will relieve your symptoms. But her symptoms were so bad, she really had no choice but to try. He said, after surgery you have no restrictions in activity and can go home the next day if she wanted. I don't know if it was the extended period of suffering and poor nutrition prior to the surgery, or the combined procedure of laproscopic cholecystectomy plus endoscopic endometriosis ablation, but "no restrictions" was very misleading. She was on pain meds for 7 days. She couldn't get out of bed, use the restroom, shower, or do anything without assistance. It was extremely difficult... the suffering continued.
Finally around 12 days after surgery she was feeling good enough to get out of the house... But the "post-cholectomy diarrhea" was pretty fierce. Oh, I almost forgot to mention, she wound up in the ER again. Sometime after being off the pain meds, she vomited and had terrible abdominal pain and diarrhea. She was admitted after the terrible pain and distress were controlled with pain meds. She was checked for Clostridium difficile infection of the colon, a complication if one has received any antibiotics. She had received one dose. The test was negative, so we thought that the diarrhea and vomiting were a virus and the pain just spun out of control because she was scared and anxious that something went wrong with the surgery.
The diarrhea continued. "it takes some people several weeks to get over the diarrhea after having their gallbladder out," they say. The cramping and diarrhea were tried to be improved with medications, with little improvement. Finally the pain became really intense and continuous, she began having low grade fever and bloody mucoid stools. In the ER, the CT scan said "colitis" the differential diagnosis included Crohn's, ulcerative coliits and infectious causes such as Clostridium difficile. Just the thought that maybe she really dose have Crohn's was scary. Her GI doctor was pretty confident the cause was going to be Clostridium difficile. To make sure, she had her third colonscopy.
Her nausea was now intractable. Zofran, phenergan, scopolamine, and reglan... none seemed to help! Finally compazine and ativan seemed to help some. This was critical, as the best treatments for C.diff are oral. Finally the C.diff test came back; it was positive! We were on the right track! It has now been 24 hours, she's only slightly better. The pain has improved. Stools were still lose and coming frequently. But she's on a treatment that works, she needs more time.
She has been suffering for 10 weeks with a rare day without some degree of pain or nausea. She's lost 8 pounds (and she didn't need to lose any). It has been hell. Why is this happening?! She didn't deserve any of it. It was also hell on me. Here I am a doctor and I can't do much of anything to really make a difference. Life seems to have hit a standstill. I really can't bear to leave her side for a moment, she needs my help. She needs my comfort. This has been the most difficult thing she's gone through. It is definitely the most difficult thing I've gone through. It's been emotional torture.
God's word says that He can work in all things to bring about good for those who are called to his purpose. So, I look for good that can come from this. I've learned alot.
What I've learned in the last week of residency.
1. I learned the depth of my love for my wife. I was ready to give up my dream of life to make her life better. For a time, when we couldn't figure out what was going on, I thought my wife could be one of those mystery cases that everyone chalks up to psych related things and the person never gets better. I thought I would live my life in our house, tending to her minute by minute. Looking for every opportunity to try and make her smile. I thought I could stop my job and work 5 ER shifts a month to make enough money and have enough time to care for her. I was willing to give up my life for her. I never knew I could love anyone so much.
2. I've learned how scary and difficult it is to be faced with health care crises. How painful hospitals are. I've never known. I took care of people every day in the hospital, and I had no idea what they were really going through. I can now have true empathy for them. I can show them a greater degree of compassion, patience, understanding, reassurance, and a greater attention to giving them information.
3. I've learned all kinds of things about palliating symptoms for my patients. Things like morphine does not last 4 hours, compazine does not last 6 hours, and small opioid naive patients can need really big doses.
4. I learned that just because symptoms don't make sense, doesn't mean the person is crazy. Don't assume its psych related until work-up is exhaustive.
5. I learned that the first diagnosis isn't always correct. Question it, if it doesn't make sense, review the information, and repeat studies if necessary.
6. I learned that 2 AM lab draws are ridiculous. I also learned that phlebotomists don't seem to mind flipping the lights on and speaking loudly to poor sleep deprived patients. Brutal.
7. Non-classic symptoms cannot rule out any disease.
8. Consider chronic cholecystitis in anyone with unexplained abdominal pain, even without typical features.
9. ALWAYS close the door behind you when you leave a patient room. You really have no idea how agrevating this is until you've experienced it.
10. I learned that medical errors do happen (they gave my wife a triple dose of morphine... she got really sleepy, I had to count respirations.)
I am sure there are more things that I've learned, but those are the big ones. I can't wait until she's feeling better and we're out of the hospital.
dngilb md
The surgeon said, 80-90% chance that surgery will relieve your symptoms. But her symptoms were so bad, she really had no choice but to try. He said, after surgery you have no restrictions in activity and can go home the next day if she wanted. I don't know if it was the extended period of suffering and poor nutrition prior to the surgery, or the combined procedure of laproscopic cholecystectomy plus endoscopic endometriosis ablation, but "no restrictions" was very misleading. She was on pain meds for 7 days. She couldn't get out of bed, use the restroom, shower, or do anything without assistance. It was extremely difficult... the suffering continued.
Finally around 12 days after surgery she was feeling good enough to get out of the house... But the "post-cholectomy diarrhea" was pretty fierce. Oh, I almost forgot to mention, she wound up in the ER again. Sometime after being off the pain meds, she vomited and had terrible abdominal pain and diarrhea. She was admitted after the terrible pain and distress were controlled with pain meds. She was checked for Clostridium difficile infection of the colon, a complication if one has received any antibiotics. She had received one dose. The test was negative, so we thought that the diarrhea and vomiting were a virus and the pain just spun out of control because she was scared and anxious that something went wrong with the surgery.
The diarrhea continued. "it takes some people several weeks to get over the diarrhea after having their gallbladder out," they say. The cramping and diarrhea were tried to be improved with medications, with little improvement. Finally the pain became really intense and continuous, she began having low grade fever and bloody mucoid stools. In the ER, the CT scan said "colitis" the differential diagnosis included Crohn's, ulcerative coliits and infectious causes such as Clostridium difficile. Just the thought that maybe she really dose have Crohn's was scary. Her GI doctor was pretty confident the cause was going to be Clostridium difficile. To make sure, she had her third colonscopy.
Her nausea was now intractable. Zofran, phenergan, scopolamine, and reglan... none seemed to help! Finally compazine and ativan seemed to help some. This was critical, as the best treatments for C.diff are oral. Finally the C.diff test came back; it was positive! We were on the right track! It has now been 24 hours, she's only slightly better. The pain has improved. Stools were still lose and coming frequently. But she's on a treatment that works, she needs more time.
She has been suffering for 10 weeks with a rare day without some degree of pain or nausea. She's lost 8 pounds (and she didn't need to lose any). It has been hell. Why is this happening?! She didn't deserve any of it. It was also hell on me. Here I am a doctor and I can't do much of anything to really make a difference. Life seems to have hit a standstill. I really can't bear to leave her side for a moment, she needs my help. She needs my comfort. This has been the most difficult thing she's gone through. It is definitely the most difficult thing I've gone through. It's been emotional torture.
God's word says that He can work in all things to bring about good for those who are called to his purpose. So, I look for good that can come from this. I've learned alot.
What I've learned in the last week of residency.
1. I learned the depth of my love for my wife. I was ready to give up my dream of life to make her life better. For a time, when we couldn't figure out what was going on, I thought my wife could be one of those mystery cases that everyone chalks up to psych related things and the person never gets better. I thought I would live my life in our house, tending to her minute by minute. Looking for every opportunity to try and make her smile. I thought I could stop my job and work 5 ER shifts a month to make enough money and have enough time to care for her. I was willing to give up my life for her. I never knew I could love anyone so much.
2. I've learned how scary and difficult it is to be faced with health care crises. How painful hospitals are. I've never known. I took care of people every day in the hospital, and I had no idea what they were really going through. I can now have true empathy for them. I can show them a greater degree of compassion, patience, understanding, reassurance, and a greater attention to giving them information.
3. I've learned all kinds of things about palliating symptoms for my patients. Things like morphine does not last 4 hours, compazine does not last 6 hours, and small opioid naive patients can need really big doses.
4. I learned that just because symptoms don't make sense, doesn't mean the person is crazy. Don't assume its psych related until work-up is exhaustive.
5. I learned that the first diagnosis isn't always correct. Question it, if it doesn't make sense, review the information, and repeat studies if necessary.
6. I learned that 2 AM lab draws are ridiculous. I also learned that phlebotomists don't seem to mind flipping the lights on and speaking loudly to poor sleep deprived patients. Brutal.
7. Non-classic symptoms cannot rule out any disease.
8. Consider chronic cholecystitis in anyone with unexplained abdominal pain, even without typical features.
9. ALWAYS close the door behind you when you leave a patient room. You really have no idea how agrevating this is until you've experienced it.
10. I learned that medical errors do happen (they gave my wife a triple dose of morphine... she got really sleepy, I had to count respirations.)
I am sure there are more things that I've learned, but those are the big ones. I can't wait until she's feeling better and we're out of the hospital.
dngilb md
Comments
Post a Comment