Complications

I know I just finished a blog a couple of days ago but something happened that shook me to the core.  I had a patient my first month as an intern that was incredibly difficult to work with. He was a guy in his 30's who abused IV drugs, was HIV positive, and didn't care if he spread it. His entire persona screamed psychiatric problems to me. One night when he didn't get his way, he threatened suicide. The next morning, he said if I called psych in to see him, he'd leave AMA (against medical advice) and throw water on whoever came into his room. He said he had no plans of hurting himself and he wanted to live. We treated his abscess, talked about staying clean, and acted like we had made a difference. Then last night happened. He came back to the hospital really sick.  He was being treated when he suddenly started getting more and more sick.  The initial thought was that he had a complication of diabetes. They were treating him appropriately and he initially got better.  Then he got sick.  When things didn't add up, people started asking questions. He told the team who admitted him that he had binged on meth for days and missed all of his medications. He didn't want to get sick so he took all his medications at once after the binge.  He wasn't sure what he took but he said he took 60 pills. As he continued to get worse, they moved him to the ICU where he later refused all care and he died.

Now what's so strange to me is how guilty I feel. I had so much animosity towards him before. He had done all of this to himself. He would complain about everything, he abused drugs to the point of nearly killing himself, and worst of all, he knowingly spread HIV. But now, in hindsight...Now...I feel somehow, somewhat responsible. Why didn't I insist on a more thorough psychiatric eval? I know that he would have likely died from full blown AIDS a short time later anyway, but what if all of this was not him doing to himself? Rather, what if this was a psychiatric disease doing this TO him? I know this guilt isn't a burden I have to carry, I am trying my best to take it more as a reminder. I can't ever be too busy. I can't overlook these details that seem too minuscule as compared to their whole medical picture. Psych was a worry I had, but with how sick he was before, it just didn't seem like that big of an issue. His reassurances sufficed for me at the time. But in hindsight? Man, in hindsight I just can't help but wonder...

~vaya con dios

"I have been favored by God, and by those who have a say in what happens to me."

As I am winding down in the last rotation of the first quarter of intern year, I find myself looking forward to my first weekend off since starting. This process has been amazing, hard, exhausting, educational, and life defining. In other words, it's been crazy!

This rotation was a general inpatient month for patients with Kaiser insurance. I went into the rotation not really knowing what to expect. Honestly, I was nervous about the variety of patients I would see. I think I was expecting nothing but privileged individuals that could afford health care and would have the elements of disease seen later in life with well-treated chronic disease previously that reached a point where all the treatments we had would fail. Instead I saw a spectrum of patients ranging from a young woman with severe alcoholic disease to a patient with terribly controlled diabetes who had her life completely changed by a SCRATCH she suffered on her leg that will likely take her life in the next year, and all the way to an old man in his 90's with pneumonia who would transition to hospice (I am beginning to learn why they call it "old man's best friend"). This rotation was actually a really good one for me (even if I am so tired) and I really did see a wide variety of patients and illnesses.

My expectations of those favored enough to have a decent health insurance went out the window almost immediately.  Illness is a horrendously great equalizer.  The uninsured patients get the same diseases that the insured patients get.  I saw beautiful relationships carrying people through their times of illness on all ends of the socioeconomic spectrum.  I saw individuals nearing the end of life alone (and really what does it matter at that point if they had Kaiser insurance or Medicaid).  On a large scale I know how detrimental to a patient it can be to go through a disease process without insurance, but really when it comes down to the day to day, as a physician, I don't want to have to care how they will pay for their treatment. I want to be a hand to hold when they are scared, I want to be a teacher about an illness or treatment, I want to be a bright spot in an otherwise dark time.

Thanks for reading!
~vaya con dios

Fall!

With the unofficial beginning of fall coming tomorrow, the dorkiness that is completing my fantasy football draft yesterday, and the start of college football season, I figured I would change gears from my usual whining and complaining about being tired and think about my favorite time of year; fall! Baseball is winding down and the playoffs are getting ready to start! I still am clinging to the slimmest of slim hopes that the Rockies can hold on and grab a playoff berth (sadly, it's doubtful though). Ubaldo Jimenez had a dream start to the season, but sadly, he had 0 run support. Carlos Gonzales is having an MVP type season, but no one (nationally, anyway) pays any attention to sports in Denver. I am afraid this team was built for success but hit too many speed bumps along the way to make the run I am hoping for. All in all though, tt's been a really fun baseball season.

The Broncos season scares me. I want SO bad to think they are going to be good. I want SO bad to have hopes that they have an awesome season. But honestly, I am the most pessimistic I've been since...ever. Kyle Orton is average at best WITH a huge receiving threat (read: Brandon Marshall). The Denver defense is scary against the pass with the league leader in sacks (read: Elvis Dumerville). The team is being talked about only for having a backup (read: Tim Tebow).  Two of those three guys are gone, and the third is going to sit on the bench. This is why I am so down on their chances. To all this, I still don't care. I am so pumped for football to start, I can hardly stand it!
Anyway, I thought I'd take my shot at writing about something different and I think I failed miserably, just rambling about something most care about one-tenth as much as I do. Sorry about that!

~vaya con dios