Debbie Downer

Today beat me down a little.  Before today, I was getting through it all on a wing and a prayer but in good spirits.  All it took was some sick patients in the village needing attention (70 year old with chest pain "like an elephant" on her chest, radiating down her arm, sweaty), multiple new admissions, and an OB triage patient raining down on me to weigh me down.

That, and the fact that a lot of these patients have just plain sad social situations.  Like the 40 year old woman I admitted with a kidney infection that had turned into full blown sepsis merely because a language barrier prevented her from understanding instructions from the ER 3 days ago.  She is a Korean speaker, which there are, oddly enough, many here, mostly cab drivers.  Her husband, a mechanical engineer by trade and trained in Korea, works as a cab driver here.  She showed up in clinic for her post ER follow up, not having understood that she needed to pick up antibiotics after her ER visit a few days ago.  She sat at home the past few days with fevers and severe flank pain from a raging kidney infection in her huge polycystic left kidney that she just found out about.

After getting her strapped in to IV fluids and antibiotics, I headed to OB triage to see a 22 yo G5P2 at 32 weeks with twins.  She has a 7 year old, a 3 year old, and nearly newborn twins.  At age 22.  And PS she should already be in Anchorage by now, where all rather complicated OB patients end up.  She had some abdominal pain (so she said), but when it came down to it, what she has is a sad, hard life, and a lot of anxiety about picking up and leaving her family behind, going to Anchorage, and bringing back twins. That's a lot of baggage.

Sprinkled in between admissions and triage, were my RMT calls (hyponatremia and a resistant urinary tract infection in the village, no planes to Bethel for 48 hours.  Gentamycin administered in the village?  Why not?) and the needs of my patients already admitted (80 year old with respiratory distress, very anemic, needs a transfusion.  And also needs to stop trying to walk around the corridor causing himself to wheeze and cough and scaring the begeezus out of everyone watching him - fall risk?!?).

And let's not even delve into another new admission from last night (well ok, I guess we will delve): a 50 year old guy who has had raging (and I mean raging) active TB for a year now, who has been partially treated twice (nice for resistance) and has managed to evade the public health nurses who have been trying to track him down for months.  He's gaunt and sickly appearing and is accompanied in his negative pressure room by his girlfriend (not wearing a mask but let's not split hairs here, they've been co-habitating for months) who says "I should probably be tested, right".  When I nod emphatically, she says, "Well, I can't have that skin test because I get a bad reaction to it."  When I ask her reaction, she says, "My skin swells up and gets red and hard."  I'm just not quite sure where to begin with these two.

I just need to shake it off and get ready for a new day tomorrow.  I will enter the wards armed with hope and a smile (and an N95 mask).