I just got paged about a patient who suddenly has extremely abdominal pain. I'm gonna go and see the patient immediately.
Morning guys. I'm Siobhan, a second-year medical resident. I'm at the hospital,
it's the weekend and I'm starting another 26 hour call shift.
Since it's the weekend there's a smaller team of doctors here at the hospital.
So it's myself, the nephrology fellow and then two staff physicians.
So between all of us,
we've got to see like 40 or so patients and then we'll all meet up in this room after to talk about the patients and
give me a heads up to see if there's anything I need to know overnight.
The first patient I'm seeing is one of our sickest patients.
She came in septic with a severe infection in her blood and her kidneys were so badly damaged that she actually stopped making urine.
It was such a shock to her and her family when she required urgent dialysis overnight in the hospital
to take over the role of her kidneys.
But now the antibiotics are working,
she hasn't had a fever in 24 hours and she's actually started making some urine again, which is a great sign.
Anyway her family was there and I was able to update them, which I think is always reassuring, so that everyone's on the same page.
And now speaking of everyone being on the same page,
I've got to document and write notes, so that the rest of the team tomorrow knows what I've done,
because I'll be post call and at home tomorrow.
Next is a young patient with a genetic disorder who recently had a kidney transplant.
Oh, that moment that you forgot that you'd finished your tea. Oh!
So we're done seeing all of our patients, we've reviewed them as a team and I think everything's stable for the meantime.
Dare I say that?! Okay.
And then my staff actually surprised us by buying us all lunch and bought me a little bit extra for being on call.
So it's incredibly sweet,
so I'm gonna enjoy that now.
Hmm I'm so graceful.
Hey, this is Siobhan from nephro returning a page. Emergency department.
Okay.
Mm-hmm.
Sure. And how much oxygen?
Great okay. I'll be down soon. Thanks very much. Okay, bye.
Okay, 1 consult from the emergency department and it looks like I got a page from a different part of the emerge as well.
So let's see if this is
what this is.
Hi, this is Siobhan from nephrology.
How high is the creatinine?
Yeah of course, no problem.
I've got a couple of consults now. Is it stable to wait for
30-40 minutes?
Great. All right, thank you.
Okay, bye.
Alright... When it rains it pours, right?! So 2 consults in the emerge so far. Let's go see about them.
So I just took a look at the blood work for this patient and
the white blood cell count is really really high and it doesn't look like a clear source.
So is this an infection, could this be cancer?
I don't really know. So a lot is gonna hinge on the physical exam and
getting the actual story from the patient.
In the emergency department I meet a 62 year old man sitting on the bed.
He tells me that he's been feeling increasingly short of breath over the last two months and that he's had some unexpected weight loss.
Plus he's been feeling a little bit warm, but he's never actually taking his temperature. So we don't know if it's a fever.
His lungs sound mildly crackly, but otherwise his physical exam is pretty normal.
He's definitely too weak to go home, so I'm going to admit him to the hospital. But honestly, there are so many possibilities
for what could be causing this.
So I'm gonna order some blood work and some imaging to figure it out.
I really wish that I had an answer for the patient right now and for you guys, but often in medicine these things take time.
Wow, it's 12:30 now. I saw those two patients,
then while I was down there emerge gave me a 3rd consult and
now I'm finally done with that for now.
Took a while. So I think it's finally time to go and get a call room key.
Hey, can I get a call room for nephrology? Thanks.
I just got paged about a patient who suddenly has extreme abdominal pain and has been vominiting a whole bunch,
which is new and has a fast irregular heartbeat.
I'm going to see the patient immediately.
Walking into the patient's room I see a woman hunched over a basin feeling sick with her nurse by her side.
She tells me the pain woke her from sleep. And as I examined her abdomen is distended
and it's painful to touch.
Knowing she's had many previous surgeries,
I'm concerned that she may have scar tissue in the abdomen, which increases her chances of a bowel obstruction.
So I'm ordering an abdominal x-ray and bloodwork right away.
She continues to vomit while we're waiting for the x-ray machine to be brought up to her room.
Finally we get the x-ray results and they make me even more concerned for a bowel obstruction.
This means there could be a blockage in the bowels, so fluid can't get through and then it builds up in the stomach
leading to pain and vomiting.
The best way to help her symptoms right away
is to put a tube down her nose into her stomach so we can drain out that extra fluid.
This will help the symptoms, but it won't actually fix the blockage. So that's why I need to call general surgery.
Hi, can you please page general surgery to this number?
Thanks, okay. Bye.
Alright and now we wait until the general surgery resident or medical student pages back to this number.
Hi, this is Siobhan from nephrology.
Hi, thank you very much for getting back to me.
I've got a patient that I'm hoping you could see. I'm concerned that she may have a small bowel obstruction.
She's had
vomiting, abdominal pain and the abdominal x-ray shows lots of air fluid levels.
This is new for her and she's had lots of abdominal surgeries in the past.
So I'm hoping you can come and see and let us know if you think she's gonna require any surgery.
Yeah, feel free to give me a page back or give me a call and just let me know what you think.
Thanks I appreciate it. Okay, bye.
1 Hour later I received a call from the general surgery team.
They ordered a CT scan and that confirmed a small bowel obstruction,
so the patient is scheduled for surgery first thing in the morning.
Good morning.
I've had a number of pages throughout the night.
Little things so I didn't really update you guys, probably because I just wanted to go back to sleep as quickly as possible.
But this morning I'm gonna quickly go and check on the 2 new patients who are a bit sicker.
And then I'm heading up to hand over to the morning team, so they can take over and I can get out of here.
Thanks for joining me on call guys. Now if you guys have any questions,
feel free to comment, I'd love to hear from you guys. And otherwise, I'll be chatting with you guys next week. So bye for now.
