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The daily life of a medical resident..
a.k.a "It's 2 AM and I'm looking at urine outputs."
White? Or was is Jackson? No - it started with an S. 
Fri, Sep. 9th 2011
Less than 72 hours ago, I cared for a critically ill patient. The details below are altered to avoid identifying information.

I admitted them to the intensive care unit, did invasive procedures on them, called consultants to assist in their care, and resuscitated them through a cardiac arrest.

I know their lactate was 104 on an initial ABG, their creatinine was 2.2, and they had been on the new alternative to Vancomycin for their resistant infection. I know that they were a code blue response in room 422 at 6:40 PM, received two rounds of epi and were shocked out of pulseless ventricular tachycardia after being intubated by the on-call surgical resident.

I know they were on Dr. _____'s service since Aug 12th.

I recall pronouncing them dead at 0105 with family at the bedside.

I did not know their name.

How is it that I could have been so intimately involved in their care, up to and including giving my condolences to their son and daughter who came to witness their last minutes alive on this earth and not remember something as personal as their given name?

When asked to follow up with a death summary by my attending, I stopped short. I could rattle off their history, start to finish with a full assessment of the likely causes of their arrest and subsequent decompensation as well as the entirety of our diagnostic and supportive efforts, but I found it impossible to recall what name to dictate the summary under.

My efforts to determine my patient's identity were further complicated; my intern, the daytime medicine resident who initially went to the code, the unit coordinator and the head nurse in the unit - not a single person could remember their name. We all remembered the room number, incidentally.

Ultimately, I resorted to pulling up all the echocardiograms done by the cardiologist we consulted for the day of their evaluation. I recognized the findings (LV hypertrophy with preserved EF and no apparent RV dysfunction or elevated RVSP indicating hemodynamically significant pulmonary embolus) and subsequently found the patient's name.

It is a sad commentary when an ejection fraction means more than a name.
Wayne State University Class 2009
Sat, Sep. 10th 2011 (UTC)
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