Diary: from a week in practice.(health care industry)(Calendar)

Publication: American Family Physician

Publication Date: 15-SEP-04

Bookmark this article Print this article Link to this article Email this article Digg It! Add to del.icio.us RSS

COPYRIGHT 2004 American Academy of Family Physicians

Monday

When beginning a week on inpatient service, I always wonder what catastrophe might befall us--and today my fears are realized. Our first patient is a 21-year-old woman with type 1 diabetes who was transferred out of the intensive care unit yesterday after yet another bout of diabetic ketoacidosis. She has since become more breathless and now, on 100 percent oxygen, has a P[O.sub.2] of 84 mm Hg with a normal chest x-ray. When I lay eyes on this young woman, she is breathing at a rate of 36 per minute. Alarmed, we rack our brains for a cause. Might it be a pulmonary embolism? Pneumocystis pneumonia? Sepsis? No explanation quite fits. Trying to complete a work-up, we trip over various obstacles. After an hour, all we have is a computed tomographic scan without contrast that our radiologist interprets as "consistent with Pneumocystis." Then, while awaiting a desperately needed nuclear perfusion study, the patient begins writhing and clawing for air. She is intubated--and almost immediately goes into cardiac arrest. A cardiologist leads our resuscitation efforts, which fail. She has died, at age 21, under our care. What a terrible, terrible day. I review every choice I made during this nightmarish morning, wondering whether...

Read the full article for free courtesy of your local library.