Saturday, January 21, 2006

What's the Rush?

I'm at Rush University Medical Center in the middle of a rotation in pulmonology/critical care. Basically, I'm on the consult service, which means we spend our day going around seeing patients in the hospital who have developed lung problems, or whose lung problems are too complicated for nonspecialists to handle.

It's a busy service, we have one attending, one fellow, three residents, plus me the medical student and we are all usually carrying 4-5 patients. We start the day around 7:30AM and often end up staying til 6pm. Some long days for what I thought would be an relatively easy month...

One of our patients is a gentleman who has multiple sclerosis (MS). MS usually affects people of Northern European descent and women are affected twice as much as men. So if someone says MS, you usually think of a young white woman, between 20 and 40 years of age. What's interesting about our patient is that he is an African-American male.

He basically came in because he had fever, vomiting and abdominal pain. He breathes through a tracheostomy, which is when they hook you up to a ventilator by making a hole in your windpipe. We're seeing him to treat a pneumonia he developed as a result of the vomiting, which happens when some vomit accidentally goes down the windpipe into the lungs. Pneumonia is very serious in MS, because it has high mortality. Nearly 50% of people with MS die because of complications from things like pneumonia, pulmonary emboli, and urosepsis.

It was discovered the abdominal pain was due to a kidney stone, which was removed, and he is doing better now, though we will not be able to take him off the ventilator. MS is a really tough condition, there is no cure and we don't know what causes it. Our patient has become so spastic (a kind of involuntary muscle tightness) and weak, he can no longer walk around, even though mentally he is intact. He likes watching game shows, and I watched a little bit of Family Feud with him...I admire his perseverance and only wish we could do more for him...

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