Tonight’s one of those nights where my pager keeps interrupting me with its shrill screams, so in an effort to feel like I’m a bit more in control, I’ve decided to log all the calls. My hope is that, by posting the pages, I can somehow exert cosmic influence in a way that calms things down a bit.

8:05 PM, from my resident: the surgery team spent a lot of time with us yesterday, explaining how important it was for them to be present when one of our patients received an interventional radiology study. Tonight, they weren’t there, and the surgery team claimed to have no idea why they would be there. We talked it through, and they’ll be there.

8:20 PM, from A’s father: A is a five year-old girl with neuroblastoma, who we sent home yesterday after the first of her two back-to-back bone marrow transplants. She wasn’t drinking so well when she went home; she’s doing equally poorly today, and her parents feel that they’re unable to push any harder without her totally shutting down. They also feel like they’re at their wit’s end, ignoring their jobs and their other daughter for the sake of getting A better. And in the end, they’re getting her better so that she can come back in for a second bone marrow transplant, to face the same issues again. We’ll work more tomorrow, but I told them to back off and let A be the boss for the next 12 hours.

9:12 PM, from my resident: this afternoon, we readmitted S, a 17 year old young woman some 100 days out of transplant, for low-grade fever and vomiting. Tonight, she can’t take any of her oral medicines, including the two that help suppress her immune system so it doesn’t reject her new bone marrow. We worked through converting the meds to intravenous doses.

9:32 PM, from my resident: it turns out that S’s kidney function isn’t so great, which definitely limits our ability to use intravenous contrast to do a CT scan of her belly. One of the best ways to prevent contrast-induced kidney failure is to use a drug named acetylcysteine, but you have to drink it, and as we know, S ain’t drinking anything. We decided to just use big-time intravenous hydration, instead.

Wow — no calls after I posted all this. Maybe the voodoo works…


Not that the smell of acetylcysteine won’t make you hurl anyway.

You can give acetylcysteine IV, though. We do it for our heart cath patients with renal insufficiency that can’t take PO.

• Posted by: alwin on Jan 8, 2004, 3:02 AM
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