Colonoscopy: to look at your heart!

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"NURSE!  NURSE!" I heard a patient screaming for a good ten minutes as I was sitting in the hall working on a computer.  "NURSE!  NURSE!!!"  I was beginning to wonder if something was seriously wrong with the patient and thinking about going in to see what was going on just as the nurse finally made it to the room:
"Yes, Mr. Johnson? What's wrong?!"
"Can I get a 7-up?"
"No."

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As a med student, part of what I do is see the patients on my own then summarize everything that's going on and come up with a plan to present to my attending (the physician that oversees the team).  Typically on rounds, the med students give a 5 minute oral presentation on each patient which covers all the relevant details and presents what we think should be done next.  (Which is often promptly followed by multiple corrections and the team doing what they would have if we weren't there at all.)  One day on rounds however, I was interrupted before even getting through the patients name by the attending spelling out exactly what she would like done with the patient.  After she had dictated everything in her plan, she turned to me and said, "Oh...go ahead with your plan."  I quickly replied, "It was exactly what you just said." with just a hint of sarcasm.

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One of my presentations on a patient ended by my saying, "At this point, we're just waiting to see what the EP team recommends after they see him."
Attending (in a condescending, "I can't believe you don't know this" tone): "No, they came on Friday.  I already got their recommendations"
Several minutes later after thoroughly discussing other aspects of the patient, the attending concludes by saying: "So we'll just wait and see what EP says before we move forward."
Another med student looked at me and whispered: "Isn't that what you said?"
Yes...yes it was.  Ten minutes ago.

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While attempting to get a history from a patient who, to put it kindly, was not medically savvy, I asked what cardiac procedures had been done.
Patient: "A colonoscopy."
Me (thinking I must have heard incorrectly): "A what?"
Patient: "You know...a colonoscopy...where they go through your veins to look at your heart."
Me: "Ah...yes...a colonoscopy.  Ok."

I believe he meant a catheterization.

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Simple Ohio?

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One patient that my team saw weighed over 400 pounds and had numerous medical issues because of it.  He needed a heart transplant, but his weight and comorbities made him ineligible.  Our attending, trying to encourage him asked if he had ever considered bariatric surgery (As a side note, I find it humorous that spell checker is trying to correct bariatric to barbaric).
He replied: "But I don't eat that much!"
Attending: "With all due respect sir, you weigh over 400 pounds, you must be eating something."
Patient (quite seriously): "Not really...but I do drink a few liters of vodka every day."

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Medical notes are often uninteresting, mostly informative and [hopefully] usually accurate, but one I saw lately had me quite perplexed.  I was reading a patient's history before I went to see them attempting to figure out what the story was before I went to see the patient and this is what I read:
Smoking history: 1/2 pack per day for 20 years, since age 15 (patient is 62)
Drinking history: 3 drinks per week, 1.5 ounces per week; drinks socially 1-2 times/month

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My attending, while describing a patient that we theorized was mentally challenged: "Maybe he's just simple!"
Resident: "That simple?"
Attending: "Maybe he's just an Ohio guy."
Resident: "What, what?!"
Attending: "No...I think he's just really sweet."
Me: "I don't think I understand how you're using these terms..."

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One patient was admitted because his ICD had shocked him ten times in 24 hours.  Having an electrical impulse jolt your body unexpectedly is life saving but can also be quite traumatic for the patients.  This particular patient was in heart failure and desperately needed a heart transplant.  Part of the work up for heart transplant is a colonoscopy - in part to be sure a heart doesn't go to a patient who has active cancer. Upon hearing that he would need a colonoscopy, the patient calmly stated:
"Man, I hope this thing doesn't shock me while something is up my butt...that would suck!"

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One patient I saw had numerous issues including a history of Munchausen syndrome, bipolar disorder and panic attacks.  She was admitted for "fainting spells" that were seeming more and more factitious as we worked her up for medical causes.  The patient was also struggling with some bad constipation and hadn't had a bowel movement in several days.  At one point, I walked in and asked: "What's going on?" to which the husband replied, "She's full of sh**."  To this day, I'm still trying to figure out which issue the husband was describing.

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AAA

I may be a nerd, but I think this is easily the coolest picture I have seen since I've started my rotations.  This is a 3D reconstruction of one of my patient's abdominal aortic aneurysm and abdominal blood vessels from a CT scan.  The fact that we can see to this detail something going on inside of a patient without having to open them up at all is incredible to me.  The ballooning out where the arrow is pointing shouldn't be there and is dilated because of a weakening of his vessel.  These aneurysms are at risk for rupturing and can be very serious and life threatening.  The faint red shapes above and beside the aneurysm are where his kidneys are, which you can see in the cartoon representation as well.

"Well, I guess she won't be a surgeon."

Well, the thing I have feared for a while happened last week.  I passed out in the hospital.  I became that med student.

I was assisting with a CVC placement (catheter placed into a major vein) and my job was to hold the pannus out of the way.  Pannus is the medical term for "huge fatty abdomen" which is always heavy and rarely easy to hold - but I had to hold it throughout the procedure.  And it was apparently a bit too much.  The procedure wasn't gross, or disturbing to me in any way - but something triggered my vasovagal response. After the procedure had been completed, but I was still holding the pannus until they could get the sterile bandage ready, I felt the room fading out.  I knew it was only a matter of time at that point and quickly said to the resident, "Can you take over for me?  I'm feeling a little lightheaded."  I was intending to sit down and wait it out, but the world went black.

I don't remember anything immediately after that but apparently the resident caught me just in time and eased me into a chair so I never actually fell.  I came to a little in the hall way, but I was still quite out of it because they couldn't lay me down.  I was somewhat mentally alert but everything was still black and I couldn't see anything.  I remember they checked my blood sugar (88 = not bad) and checked my blood pressure (75/50 = very low!) and then they finally were able to get me into a bed and I instantly felt much better.  Once I was able to rest for a bit, drink some juice and eat some crackers, I was back up doing my work (despite them telling me to go home).

All in all, it was slightly embarrassing, but it could have been much worse.  I didn't get hurt and they didn't call a code blue (which they're supposed to do if anyone falls).  I heard a few jokes in the following few days, but it was to be expected and I threw some out as well.  The resident gave me quite a glare the next time he was placing a CVC and I asked, "Need any help with the pannus?"  Later, when I was assisting with another procedure, he looked at me and asked, "You ate breakfast, right?"

Just as I was waking up that day, I heard a nurse sum it all up beautifully: "Well, I guess she won't be a surgeon."