n***j 发帖数: 184 | 1 Night float today is boring. R3 just told me that I could do a central line.
I was very excited and consented the patient. Then, she told me that the
patient was on heparin, perhaps it would be better if an R2 did this. I
smelled "Yes, no problem" and said " F*** " in my mind.
Anyway, next session of the intern story. I wrote this one a couple of weeks
ago and some of it was about my thought on the debate about the "multiple
myeloma patient from Hangzhou saw US doctors."
一转眼已经5月,新的一批intern已经在问哪里租房好。( Last year, I spent one
day and found a bedroom close to the hospital. It was great in price and
location except for that it was by the street and the curtains do not block
the light. Super painful to fall asleep after night float sometimes.)
医院的intern入门手册需要跟新,我和两个同事接了这个活。1年前看这个手册很害怕
,觉得自己什么都不懂。一年后再看,知道了不懂的远不止我一个,也知道了有问题该
问谁。进步很明显。第二年将至,很紧张。带我的resident说:“第二年开始的时候很
可怕。不过,你的intern会给你信心。”我作为他的intern,听了不晓得该说什么。他
接着举例子:“记得有病人血糖30几,intern就不知道该怎么办了,是不是要抢救?是
不是会死?我很随意地指示到,病人能讲话,要不给他来瓶可乐?”我一边嘲笑他的
intern,一边又觉得这个故事似曾相识。 ( He is a second year now and this
story was obviously about one of my co-interns. I could see myself panicking
at this too easily several months ago.)
这一年很快。第一个病房是肾内科。我假装积极地前一天晚上就去巡视了我的病人,第
二天查房却忘记了看早上实验室检查的结果( I did not know what AM lab at that
time.). 第一个夜班护士告诉我病人血钾8,带我的chief问我该怎么办,我说要不试试
胰岛素。他说,你先忙别的,这里我来,记得一会儿看一下心电图。2个小时以后,我
把心电图拿给他,他说复查血钾已经正常了。早会被提问,花了5分钟,我终于看到了
壁的ST抬高。现在最常听见的话就是,“这一年你们走了很远,学了很多,只是你们自
己不知道。”想到自己当初起点之低,觉得这话好像不假。
3年前,我写过国内外医院的差别。经过这一年,我可以更好地回答这个问题。我不认
为这里医生的技术水平比国内我实习的医院高,尤其是每年6,7月份新intern,
resident和attending上岗的时候。这里病人确实是有更好的随访,更好的就医环境,
甚至是更好的病床。病人可以固定地看一个医生5年,10年甚至更久。出院也不就是直
接回家,更多是去康复中心、疗养院或者是有护士按时到家里去。在国内满是病人的门
诊或者病房走道里,这些是难做到的。只是医学可能不只是技术:除了电生理实验室里
无比犀利地清除病灶,还是每个礼拜定期无聊地复查INR。无影灯下无所不能地移植心
脏之外,也需要繁琐的移植前排序名单。这个路,还很长。
对于杭州那个到加州看骨髓瘤的故事,我非常喜欢微博上的一个留言,大意是”他如果
在杭州准备手术住院,查血常规,不正常,然后血液科会诊,然后骨穿、化疗,绝对花
不了在美国的几十万。” 我想如果真是这样,邵逸夫的黄主任可能会看到这个病人。
我非常确定的是他读的指南和这里的医生是一样的。不同的是,邵逸夫的病床是远不如
加州的软的。而国内更多的病人,根本是连病都看不起。想到这里,只能觉得很无奈。
在波士顿去纽约的长途汽车里一觉醒来,感觉还是在宁杭高速上。仔细一看,左手边的
,并没有太湖美。( I went to NYC in my second vacation and met some friends
there. I guess I must miss home at that time.) | c*****8 发帖数: 112 | 2 Beautiful ending, I love the story | p********g 发帖数: 372 | 3 我第一个夜班也是遇到个低血糖 40多,看着病人活蹦乱跳的,就讓护士給瓶juice,再
看。结果护士嫌我太大胆,硬逼着我推了支D50, 才让我睡觉。现在回头看看,除了
senior,护士们教了我好多啊。
上回好可惜,没见到你,错过了一顿,下回来提早通知哈。 | b*********e 发帖数: 158 | 4 nice job, well done
first year almost gone, enjoy your pgy2. | w******u 发帖数: 33 | 5 赞床软!
想起了一开始连Lasix都不敢开、K也不敢补、Dictation还先打出来再读的日子……
那天吃龙虾跟你聊起来,才觉得自己真正成长了许多 | t******a 发帖数: 408 | 6 very appealing story!
今天到MICU见习, 感慨USMLE的高分只是基础, 真到了临床还有huge gap需要填补。
Thanks a lot for sharing. | t******a 发帖数: 408 | 7 "我第一个夜班也是遇到个低血糖 40多,看着病人活蹦乱跳的,就讓护士給瓶juice,
再看。结果护士嫌我太大胆,硬逼着我推了支D50, 才让我睡觉。"
From what I read on this topic,
1.Your mgmt w/ juice is a right decision ---- for pts who are alert, can eat
/drink/swallow ---- give juice/peanut butter..., maybe even Coke:-);
D50 is for those who are LOC, unable to eat/drink/swallow; or not responsive
.
2. important to recheck BS every 15 minutes until it reaches 70.
3. BS --40s, not likely to cause coma/death.
njwwj (Njwwj) or any 前辈: could you please comment and give us the right
answer?
Thanks a lot! | p********g 发帖数: 372 | 8
eat
responsive
你是对的。Protocol这么写。可是夜班病人各种奇葩,有拒绝这个的有拒绝那个的,而
且第一个夜班各种不自信。我忘了具体原因为啥要用D50,好像是病人嫌烦,不肯再喝
了。
【在 t******a 的大作中提到】![](/moin_static193/solenoid/img/up.png) : "我第一个夜班也是遇到个低血糖 40多,看着病人活蹦乱跳的,就讓护士給瓶juice, : 再看。结果护士嫌我太大胆,硬逼着我推了支D50, 才让我睡觉。" : From what I read on this topic, : 1.Your mgmt w/ juice is a right decision ---- for pts who are alert, can eat : /drink/swallow ---- give juice/peanut butter..., maybe even Coke:-); : D50 is for those who are LOC, unable to eat/drink/swallow; or not responsive : . : 2. important to recheck BS every 15 minutes until it reaches 70. : 3. BS --40s, not likely to cause coma/death. : njwwj (Njwwj) or any 前辈: could you please comment and give us the right
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