yesterday i admitted a 28 year old man with past history of alcoholic pancreatitis, complicated by a pseudocyst. his belly was soft and not particularly distended. i thought this would be a quick few days of managing his pancreatitis and withdrawal and sending him on his way.
today i get a call from the radiologist, that on the follow-up CT i ordered he was noted to have a 12x10x14cm complex mass where his previous pseudocyst was, with possible solid components, hemorrhagic components, and intraperitoneal hemorrhage/ascites. that morning, his hemoglobin had dropped from 11 to 6 without hematemesis, hematochezia, or melena.
it was so completely overwhelming. i was just thinking, well i have to get surg, IR. then i couldn't reach IR, the operator had the wrong number. i was so despondent by the fact that this guy could potentially bleed out into his stomach and die, and it would be because i couldn't find someone smarter than me to handle the situation.
i think i will be forever grateful for the GI specialist. he gave me some reassurance about the case. he even told me that he himself reached out to a surgeon he knew at a nearby hospital for advice! and ended with some feedback to always call him with this type of complication. he didn't think the patient was actively bleeding into the pseudocyst, that it was old, and that urgent imaging/IR/transfer was probably not warranted right now.
i remember my first really memorable case working here. an elderly japanese-american woman coming in with AMS. the next day, i happened to be there the same time as the ID doc. he had enough gumption to roll the patient over, which i did not do. and lo and behold, along her midline lumbosacral area following a dermatome, she had a vesicular rash. her csf later tested positive for VZV. my first zoster meningitis.
i remember a near-miss. a lady with history of renal transplant, then subsequent colon AND lung cancers. coming in with UTI. i was about to send her home on her regular home meds when the renal specialist noted her pancytopenia and said, you have to call her transplant team before you let her go. and that's how i learned that transplant medications should be changed depending on certain situations. oh boy, i was so angry with myself that i didn't know even the basics of transplant medicine.
and another near-miss! an older man with history of renal transplant, with ESBL UTI whom i had to send home on meropenem, forgetting that i had to discuss with his nephrologist prior to putting in a PICC.
oftentimes, i feel that i am not cut out for inpatient medicine. compared to where i trained, the cases at this institution are so complex, and then i've never done inpatient onc in my life, and it seems like every other person in this goddamned town has cancer. this week alone i had three patients with brain masses.
this has been an important learning experience. sometimes, i justify quitting, telling myself "it's my personality, i take things too hard, too much to heart, as opposed to thinking through them in a calculating fashion." or, "i am just too stupid to do this." there was a click-bait article that i clicked on, "amateurs vs professionals." one of the items on the list is,
- Amateurs give up at the first sign of trouble and assume they’re failures. Professionals see failure as part of the path to growth and mastery.
i sure hope this is what a natural path feels like.
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