Good resident, good intern, good medical student ... I lucked out. Only a handful of patients at a time (today we had 5), but they are so multi-presenting that there was no lack of things to take care of. Dialysis monitoring, insulin regulation, nutritional consideration, meds, labs, charting. My background education in physiology is coming into gear at full throttle. Many, many details to keep track of.
One of our patients is an older woman in her 60s, who has ESRD (end stage renal disease). She has hyperparathyroidism, which is resulting in high levels of calcium in her body. The calcium has nowhere to go, so it deposits in the tissues, including blood vessels and the valves of the heart. She is being given a calcium-binder, but it can only do so much ... she needs dialysis every day for a minimum of 4 hours. Problem is, she is non-compliant and leaves after 2 hours. I'm not sure she understands that she's basically killing herself because her blood is not being properly cleansed of the overload. I saw her in dialysis today and reminded her that she needed to stay as long as possible, and made sure she had a TV to watch. She'll be getting an X-ray tomorrow to look for blood vessel calcifications in her legs. Oh yea, that's the other thing about this patient, her legs and feet, due to the lack of adequate blood supply, are dying. They're developing sores which can't heal and she will most likely need amputation. Very sad, but even more tragic when you consider that her lazy attitude is such a strong contributor to her condition. You can lead a horse to water ...
I'll be given my own patient(s) to follow tomorrow, so I'm really looking forward to that.
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