There is a patient on our service with an endometrial cancer. Today was around a week since her surgery. On admission to the floor post-op, we put her back on to her home med of coumadin, but added fondaparinoux (arixtra) and ordered for daily INR. The INRs were not done, so we were never aware of how "thin" or "thick" her blood could be...not that it makes a huge difference on what was to come... She coded before we came in to the hospital today, and was revived by the team and transferred to the ICU. We replaced lost clotting factors, loaded her with fluids, gave her vasopressors, put her on ventilator settings, gave her blood/fresh frozen plasma/vitamin K/albumin etc etc etc. Critical care is an understatement, this patient got the works. And my fellow med student and I kept a careful eye on her all day. Every half hour or so we'd stop by and check up on her, look at her labs, speak with the physicians, talk with the nurse... whatever it was that caused this to happen, we felt partly responsible, so we wanted to be there for her to help her get better. Even after 14 hours in work, I am sat here at home thinking about her, wanting to do more. But not so long ago this evening, she coded and CPR was stopped. It feels like such a failure.
While she was being aggressively resuscitated, her blood pressures couldn't tolerate sedation, so she was completely conscious earlier today. We didn't realize that she was conscious until my partner put her hand on the patient's hand, and the patient squeezed back. What a horrible thing, to see someone trapped in their body, on a vent, in agony, bleeding out... horrible. I feel like we let her down. While she did have an extensive list of health concerns, I can't help but feel like I could have helped to prevent this. But such is life. Death is hard, especially when it occurs unexpectedly.
After work, I had my OSCE. I had to perform a breast and pelvic exam on a standardized patient. I did well. The evaluator and the patient mentioned that I did a great job in explaining things, I made them feel comfortable, and I came off as very professional. The attending then told me that I am "obviously a people person; you should definitely go in to clinical medicine - what field are you interested in?" (I replied "oncology of some sort"), and he said "hmm, maybe gyn-onc! You should consider it." I do love feeling like I would be an asset to the program, feeling like I am being recruited. I definitely feel like I belong. He also said that oncology was a perfect field for me. It's so nice to hear those words come out of such an experienced and knowledgeable physician.
It's been a long, hard day. Time to snuggle up with my doggy and watch her favorite movie, "Lady and the Tramp". Marley has a way of making me feel better, no matter how bad my day has been...
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