Day 515: Crap !

wow...well not sure where to start. It was around 4:30pm and I was about to sign out my patients on the floor, when the nurse on my bed 5 came into the resident room and said "the sister of bed 5 is here to talk to you." As I walked towards bed 5, I couldn't help but be glad to be able to talk to her. I had been talking to her daily about her brother and giving her updates and she seemed to be on board and was always cooperative and friendly. (I didn't know what I was in for.) As I walked over the room I can see a mature woman in her 50's outside the room crying and being held by the father of the patient. I had seen him before daily at the bed side, and always spoke to him daily. I went up to her briefly, but I sensed that she wasn't who I was talking to over the phone. So I then proceeded to go into the room. I walked in and the mother was at the right head of the bed, and the sister was at the left side of the head of the bed. She had her hand on her brothers head, and she was rubbing it and telling him how much she loved him and how much she cared for me. (He had been intubated in the ER for airway protection after he was found to be in delerium tremens and was extremely aggressive- pulling out iv lines and almost hitting the nurses. He also got a case aspiration pnuemonia and was in ARDS. He had been on the vent 13+days and was a candidate for Tracheostomy if we are not able to wean him the next 2 days.)

After she spend a few minutes "talking" with her brother she came over to me and I introduced myself. We spoke a bit and updated her on his progress. Then all the sudden the intensives/pulmonologist walked into the room to see how he was doing. (we had been trying to wean him off the vent and he came to see how he was doing) He walked in without greeting us and went up to the vent.I followed him to see what he would say. He looked down on the patient and said. He doesn't look like he will be weaned, his stomach is assisting his breathing, and just walked out of the room. The daughter asked me who was that, and I said that he was one of the pulmonologist that was on the case. (I got a sense she didn't like him very much. He is usually straight forward talking and is not friendly with everyone, but he is probably the best intensive pulmonary attending in the area. He has a "super surgeon" type personality- overly confident,aggressive and cocky, which would be the personality you need to be an intensive care specialist) We stepped out of the room and she spoke to me at the outside of the room.

She said "so how many years have you been practicing medicine?" the question caught me off gaurd. I said "I'm a 2nd year resident. I have been one for 1 year and a half." She kind of look perplexed and said "And what were you doing before that?" I said "I was in medical school before that." Probably not the best answer to her question, but I didn't want to lie to her.

She then said "And why is it that every time I talk to you, all I hear is- maybe,possibly, most likely, hopefully?" I didn't know whether to laugh or to argue back, so I decided to stay quiet. She seemed a bit angry. "And who was that doctor that walked in? I don't appreciate and like his bed side manner.He just walked in and was not very polite." I told her "he is one of the pulmonary specialist and intensive doctors working with us. He is one of the doctors on the team." "well you know what, I want to talk to him." At this point, I knew things were about to get worst. The pulmonary attending was sitting right behind us and was on the phone. As soon as he got of the phone and continued to write a note he was writing she came up to him and said "HI. I would like to talk to you. what is your name and number?" He looked over her and said "ok" she then continued and said "and you know I don't like your bed side manner. I want you to stand when you talk to me!" At this point the other residents had walked into the area and I looked over to one of the seniors and she stared back at me as if saying what the heck happen here?. He stood up as if he was about to kill someone, but remained calm. "who are you ?" He said to her "This is my brother you are talking care off." He said "I'm not his doctor. He is not my patient I just came here, I was covering for the other pulmonologist who is on vacation. I saw him today for the first time" She then looked at me, I tried to become invisible, but it didn't work! She responded "What?" he then said, realizing what he had just said "I'm the pulmonary doctor for today and I know what has been going on with him and I'm taking care of him for the next couple of days."

"do you think he is getting the right care here? how long have you been a doctor here? He stood quiet 2 seconds then said "I've been a doctor here since 2001. I wasn't aware of who you were so when You approached me the way you did I was taken back. But I can tell you that he is getting all the proper care. If you feel he is not getting the proper care you can always transfer him, but I don't think you should."

He then went on to tell her what he thought about his prognosis and the fact that he might need possible tracheostomy. She then asked a few more questions and seemed to be calm for the moment. I was going to walk away and run to my bat-mobile plane to fly home, but I realized I hadn't signed out yet to the resident on call, so I decided to stay. I then went over to the sister and tried to calm her down. I told her "I think that you would feel comfortable if you spoke to the primary care doctor, he would help you with any of your concerns,. And anything you need please don't hesitate to call us." She seemed a bit more calm, and then ran-walked over to the on-call resident to sign out.

I signed out and then got in my car and drove off.... I felt as if though I had just dogged a bullet, but this wasn't the matrix, and I still have him for another week. I'll let you know how it turns out. If I write another blog, you will know that everything turned out ok.

God Bless you
Dr.mike

i.e. I found out that the sister is bipolar. The mom told us. Well i guess that could explain a few things.