This week, Jessica and I have our Respiratory rotation. We followed Dr. Chien, Chief of Pulmonary Department, in the ward and OPD yesterday. Today, we followed Dr. You in the ward and Dr. Lin in OPD. We were also expecting to give our Colorectal Cancer presentation on Monday afternoon to the Internal Med Department, but it was cancelled and will be rescheduled soon.
At the ward with Dr. Chien, we saw a patient with empyema from Klebisiella infection. After he took Ceftriaxone, he had allergic skin rash, but decided to bear the rash and continue the medication. There was a 89y/o patient with pneumonia, in addition to pressure sore necrosis (bedriddened for over 6 years), hip fracture, septic shock and UTI. Her body position had to be changed every hour or so to avoid localized pressure buildup. Since Dr. Chien is a TB expert, he was also taking care of several patients with active TB. There was even a patient with MDR-TB, meaning that the strain is resistant to INH and RIF. Dr. Chien brought us to the secluded side of the hospital where TB patients lived in isolation. All the rooms are in negative pressure, and I feel fortunate to have been able to see such a secluded part of the hospital.
The next morning in the ward with Dr. You, we saw a patient with BOOP (Bronchiolitis obliterans organizing pneumonia), which is a very rare case. This patient was had Xray image and symptoms that mimic pneumonia, but the underlying disease is actually inflammation of the bronchioles. Patients are usually diagnosed with BOOP after antibiotics for pneumonia do not work, and sputum samples are repeatedly negative.
We visited a 34y/o woman suffering from OHCA (out of hospital cardiac arrest). She was on ventilation, in a vegetative state and was jerking uncontrollably. It was heart-wrenching to see someone so young to be in such great distress. What was even more difficult for me was seeing how much family members suffer. There was a woman whose 90y/o mother was under respiratory care in the hospital. The woman was very concerned about her mother and prepared a long list of questions to ask Dr. You. She repeatedly apologized for asking so many questions, but expressed her desire to learn more about her mother’s condition. Although Dr. You had a long list of patients waiting to be seen, he welcomed each of the woman’s question until she was satisfied. I could see that Dr. You developed a strong rapport from his patient. To me, that was just as important, if not more, than knowing how to treat patients. We discussed a bit about establishing doctor-patient relationship. Dr. You advised us that it is important to let the patient and family members know that the physician has done everything they can possible do to help the patient. Physicians cannot be expected to heal every patient, but they can let every patient and their families know that they are doing the best they can.
In the afternoon, we followed Dr. Lin who mainly sees trauma patients in OPD. A patient came in with hemopnuemothorax. He was walking when something hit him on the chest. Dr. Lin said that patients like these need to be hospitalized for at least 7 days to see if hemopneumothorax develops, so they shouldn’t be let out of the hospital before 7 days.
There was a 32y/o man who came in with trauma scars and stitches all over his body, especially on his knee and arms. Dr. Lin removed some of the sutures on his body. He taught us that in order to remove sutures, one must pull on the suture with tweezers (the aseptic part comes out), make the cut on the aseptic portion of the suture, and then pull on the other side of the knot so that the aseptic part goes underneath the skin and come out from the other side. This is an extremely important surgical technique to prevent sepsis. The man was involved in a traffic accident and his injuries reminded me of the importance of driving safely, whether one is in Taiwan or America.
Tomorrow, we are going to Dr. Chien’s TB clinic at another site, I cannot wait!
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