To poop or not to poop.....that is always the question

The day started off pretty normal....i was at the office and we had 15 appointments to get through between the hours of 8am-12 noon.....Because my doctor had ER call from 8am-8pm the calls from the ER started early so we had to get through the all the appointments and get to the ER to start the admit process.....i had a feeling today was finally going to be the day that my hospital H+P cherry would be broken......at this point in the day i was still optimistic and excited about working in the emergency room...

i thought it would see George Clooney, have some glamorous day and excitement.....oddly enough the day wasn't too far off from that, but in some other sense it was completely off....the best part of watching ER on TV is that you cant smell it...and this is how it starts...

Again the word of day is POOP...so that is the warning...

by the time we showed up at the ER after lunch at 12noon we already had 12 patients waiting and more were coming in as we were waiting....before we could see those patients, i went upstairs to discharge 3 other patients with the doctor, we were sure that no orders had to go in for anyone critical...

by the time we actually started seeing patients in the er the time is close to 2pm... just so you have an idea, the job of the medical student is to get a full H+P (history and physical) on each new admit (patient that already has been seen by the ER doc, who decides they need to be admitted to the hospital) that is when i get to see them, take a history, perform a physical, evaluate some labs, and write up admit orders....after i finish i present to my doctor who in the nicest way possible generally tells me where i screwed up, and corrects the mistake so nobody dies....usually he knows a little about the patients before he sends me in, so i don't see any of the super critical patients....

What i first noticed about the er is the absolute organized chaos that is constantly going on, in addition to the ubiquitous smell of poop....it smelled like the emergency department took a major poop....then i realized that most of the patients had bowel movements, diarrhea or some form of fecal matter in the close vicinity of their bed/belongings....

I started taking histories on patients and realized how amazing it is that people will answer some of the most personal, disturbing questions as long as the person asking is wearing a white coat with a stethoscope....and the other part that is almost more amazing is how much i enjoyed asking patients about their bowel movements, habits, color, consistency, frequency, odor, texture, size and any other description i could think of relating to their poop....asking about discharge, blood, mucus or other secretions that come out of their rectum....i actually enjoy talking to patients about their poop and i am able to have them answer me in a very serious manner...

there is so much you can tell about a person, their overall health and current problems by asking questions about the poop its nearly unreal....i am thinking about starting a collection of interesting diagnosis that i come across based on poop.....seriously i could see a book named, "POOP" clearly there needs to be a subtitle but i am not nearly clever enough to think of one....any ideas feel free to post...

i as a med student also get to perform one of the most exalted and important physical exams in all of medicine.....the RECTAL EXAMINATION.....its truly a joy....i am the person that checks for rectal bleeding...its not really a glamorous job but a very important job and one that i intent to take very seriously...i am going to be the person that confirms the fact you are bleeding by sticking my finger in your butt, so when the labs come back with a decreased Hb or Hct i can say, 'yes, he is bleeding' and confirm for everyone...really, when someone comes in complaining of rectal bleeding, why do i have to stick my finger in there to confirm it...

isn't it like standing outside in a hurricane and telling me, i think the wind is starting to blow? and i think it may rain soon?? exactly, captain obvious of course its windy and raining in a hurricane that is why they call it a hurricane....for the same reason they call rectal bleeding, aha, rectal bleeding....

basically i am one step above patient in the terms of hospital hierarchy esp because i still don't have computer access....but that will be tomorrows big mission, to gain access to the computer system so i can check on patients without having to ask a nurse to sign me in each time i need to get lab values....i think i have summed up quite bit from my long day....

here is a sampling of the 24 patients we admitted before i was sent home at 6:45pm (my doc was on call till 8pm)...

drug overdose, exacerbation of crohn's disease, non-ST elevation MI, bells palsy, herpes zoster, malignant hypertension, suicide attempt (he stabbed himself in the stomach), drug seeking patient with chronic back pain, fever of unknown origin, pneumonia (AIDS patient), acute pancreatitis, fatigue (leukemia), UTI with signs of altered mental status, pulmonary embolism, explosive diarrhea,....

and these were just the patients i got the opportunity to take histories on, or at least partial histories....and physical exams...tomorrow is going to a day of rounding on all those patients, and hopefully discharging some of them, or incorporating a few more consults on the case to determine what the hell is going on with some of them.....hospital patients are actually pretty complicated.....who would have thought, managing HTN(hypertension) and DM (diabetes mellitus) in the office are much easier but as i learned today, office visits in primary care doesn't pay as well as hospital work.....and treating patients in the CCU pays the most followed by ICU and then general medical is the lowest but still higher than office visits....that may vary in a different speciality but in primary that is how it works...i learned that today...


well that is enough for today, i smell like the ER (mainly like someone just pooped their pants), so shower and bed is on the plan for the rest of the night so i can get up early and do it all again tomorrow.....i hope we didn't get more than 30 patients, cause that is a lot of patients to round on....but at least there are only 6 floors to the hospital so they are going to be close to each other...

more tomorrow!!! feel free to post requests of what you want to hear more about, or less, or questions/ comments....i may not listen but you never know if you don't ask....