Catching up

Hello readers,

I grew a bit tired of blogging, which is strange since I have basically way fewer patients to see and therefore more time during the day.

On Wednesday, yet again, my attending changed. And if I was impressed with the last one, this new one is even more incredible. She has never admitted to her actual age, keeps making up numbers jokingly. So I'll have to guess her at around 35. She's born in Chicago, daughter of a sociology major and a physician somewhere in Switzerland, I think. She studied European history in college, which is where her comments about Hegel she shot at me during rounds must have come from.

When I first saw her, in the ER, she was in the middle of listening to the presentation of a patient by the ER resident. She was scribbling down things on a pad, looking up the patient's labs and sending text pages on the computer while intermittently grabbing the phone when her pages were answered. In between, the attending shot short questions towards the resident when she had forgotten to mention something. She would talk fast, but friendly. It seemed like she could remind you that the thing between left atrium and ventricle was the mitral valve and still make you believe that it wasn't a big thing to forget and that it could happen to anyone. In the middle of all of this, one of her ever-moving hands reached out towards me, she smiled and introduced herself to me with her nickname and last name. I had time to shake that hand and say my own first name (I have given up using my last name permanently over here) before the fraction of her focus I was allotted at that time was taken away again. I didn't mind, on the contrary, I was pleased with her productivity. Rounds would be good.

And I thought Jen was the embodiment of the ability to multitask - this new attending was like Jen with a quad core processor.

A resident I know from renal consults, who is now on the ICU team that the new attending also rounds with, found a nice way to describe what her impact on her surroundings is. While the new attending - let's call her Brainy (heheh) - was busy working up a patient with the rest of the team and the ICU staff, the resident and I stood to the side and he muttered to me

"dude .. she's like a tornado."

True. But now in this picture that I've drawn so far, you'd probably imagine Brainy to be excited or appear stressed-out. And here's the strange thing, that couldn't be further from the truth. She's more laid back than almost any attending (except for the first one I had over here, no one can match that guy when it comes to taking life easy). She'll never speak in anything but a calm tone albeit fast and direct. Every other phrase coming out of her mouth will be ironic or funny in some other way but to the point. At the same time, she will never try to make you feel inferior (you just inherently do) despite the fact that the collective jaws of the heart failure team will drop every so often when she just never seems to run out of answers to just about any question there is.

For example - a patient post heart transplant turned up with undulating fevers that no one in the hospital could find a reason for in the past weeks. Outside the patient's room, while flying through the pages of the chart, Brainy asked for the patient's tacrolimus level (an immunosuppressant for the transplant). It was rather high. Brainy frowned a bit, skipped ahead to the medications list and then asked the nurse practitioner to hold his tacrolimus dose for three days. She also said that they shouldn't even bother drawing blood for another level tonight, it would be high again. Naturally, the team sported blank expressions and one of us managed to blurt out the question how she came to these conclusions. She pointed at the medication list, specifically a rather new order of voriconazole and looked at us with wide, but friendly eyes. This didn't help us much so she quickly explained that voriconazole will inhibit cytochrome P450 3A4/5, which is responsible for tacrolimus metabolism. Uh-huh. Well - you can still write this off to being her tools of the trade. She's in heart failure and involved with a lot of transplants. Big deal. But it got better.

After asking this same patient questions that we could halfway relate to about contact to kettle, cats and rabbits the patient said he hadn't had any contact to those kinds of animals. Oh, just his niece had brought a turtle. Instantly, Brainy asked the nurse practitioner to add cultures for salmonella. Turtles have salmonella? Of course they do. Did any of the rest of the team know that? Nope. After Brainy imparted some more wisdom on the patient (including how to clean your ears without a q-tip) we left that patient's room and Jess confronted Brainy with "how do you know all this?". Brainy just downplayed it as not being a big deal as she would always do.

But this woman is not limited to theoretical knowledge. We rounded on another patient who had broken his leg while carrying another person's heart in his chest (which is where we came in). He was going to be operated on by ortho as soon as the swelling in his leg would go down and his platelets (that were down for some unknown reason) were back up. Now, cooling the leg would have been helpful with the swelling, right? So Brainy asked the primary team's resident that took care of the patient why there was no ice on the patient's broken leg. The resident replied that he had written for it, but the nurses couldn't do it because the ice packs they had were too small for the leg, they'd always fall off. Brainy abruptly went to the nearest garbage container, took out the trash bag and gave it to me to hold, grabbed a fresh garbage bag that they keep inside these containers, went to the ice machine in the nourishment room, filled it and that was that. While doing all this, however, she would NOT give anyone a hard time about it. She would not even say anything about people having lost common sense and practical skills somewhere around their medical training. I challenge anyone to not even making a single remark in that direction in this situation.

The next day, that same patient was to receive one of those little plastic machines that you blow into for breathing exercise. You know, with the three little balls you have to blow up. The resident said he agreed that he should have received that thing and started practicing the sooner the better but the nurses just hadn't gotten around to giving him one yet despite him writing the order. He was a rather tall resident, so he had to duck when Brainy opened a closet high up on the wall right in front of the patient's door. It contains a number of frequently-used items in patient care, such as urine cups, syringes, foley bags - and the little plastic breathing exercisers. She took one and handed it to the resident. She also advised the patient to drink a lot of cherry juice and stay away from watermelons during the summer. By now, I have totally forgotten why but I'm sure it makes total sense just like all the other pieces of knowledge this attending has been spraying out.

Can you tell I'm a fan?

Now don't get me wrong, I believe I couldn't stand her personally if she kept up the pace she brings to work every day. But since I only see her at work and we have a minuscule patient load I get to profit immensely from her - since she enjoys teaching.

Problem is that CS, Jess and Brainy all keep stacking journal articles on me "to read" - the number of these being only directly proportional to the amount of bad conscience I come to work with, since the number of articles I'll read will remain constant right around zero.

In other news, after interviewing the director and an associate director of the residency program in internal medicine the chicagoans got togetherand worked on the mentoring system we're supposed to institute at our medschool back in Munich. It's slowly taking shape and at least I for one believe that it's going to be an extremely cool program.

And on Friday all of the chicagoans came to Looptopia - a brand new festival premiering this year in Chicago celebrating the loop.There were artists on the streets and numerous events all over the buildings around the loop. It wasn't that much of a success for us though, since we didn't have much of a plan of what events to go to and we ended up waiting in line most of the time and giving up and walking out somewhere halfway through.

Allright, that should do for now and keep you busy. I'm off to do happier things like finally finishing that book on EKGs or something.

Blog to you later.