Skip to main content

Sleep deprivation and doctor's notes

I'm no stranger to being awake for a 24-30 hour straight shift, but last night the sleepy delirium hit me in the middle of writing my admission note. During these wakeful-sleep moments, my brain tends to move from relevant thoughts to far off tangents. If my hands are on a computer keyboard when that happens...well, you'll see:

59 yo M with history of IPF admitted with dyspnea
1. Dyspnea - not likely IPF flare as able to wean very quickly. Would get an ICU overflow bed
- CT chest to evaluate nodule seen on CXR
- Sputum, blood cultures
- continue O2
- PRN albuterol-ipratropium
- continue prednisone/albuoterl as a guest speker
- would also like to add rifaximine. 
2. Lower extremity swelling - inadequate dose of lasix vs hypotension. dkl;
- will give IV vanc at 116%
-
3. Cor Pulmonale - Will get RHC, orthostatics, and WBC count together day? 
4. SIADH - stable, serial BMP 
5. Compression fracture - will continue home medications for pain. 
FEN/GI - Will give patient 3 g 5 CHO diet, low Na 
Dispo - Hpatient iwth risk of rincreased infection to due low of be louie s

What is really scary is that I knew I was sleepy and was actually making "corrections" to my mistypes. I can only imagine what kind of plan I would have had if I hadn't edited it.

Needless to say, a fellow resident caught my note in the morning, and I rewrote the whole thing.


Popular posts from this blog

One "block" laid on a growing foundation

Sometimes you find that you're right where you're supposed to be. That might be the right city or town to live in, or it might be in the right kind of relationship with the right person. Maybe it's as simple as the right place at the right time, and events around you seem to be working solely for your favor. For me recently, it is finding that I am heading in the right direction on that oh-so difficult path known as a career. Wait, I'm going to have to admit something here first. I just spent about 15 minutes coming up with that catchy opening. Don't worry though, at least a third of that time was in retyping it after it suddenly disappeared for reasons known only to...well, no one really. Alright, now back to telling you just where I'm going with this new blog of mine. My name is James, and I'm a first year medical student at the University of Missouri - Columbia. I just graduated college this past May. It was in college, between my first and second years, ...
Read more

The $2000 monkey on my back, deferred

It’s been more than a week, and I think an update is due. Plus, I can give updates on my own status with my heart murmur, having seen the doctor this past Friday. The only thing that has kept me from updating until now is simply laziness (in other words, I was far too busy studying/eating/cleaning/sleeping to actually relax and write). This past Friday I went to the Student Health Center to see my doctor about the previously mentioned murmur recently discovered. My doctor presumed it was most likely an innocent flow murmur, which occurs if a heart valve doesn’t close all the way or in time when the heart beats, allowing blood to flow back the opposite way, and the blood causes turbulence heard as noise. If you’ve ever heard turbulent water flowing over and through rocks and back upstream in eddies in a river, you should get the idea of what a murmur is. It was recommended that I have an echocardiography done, or an ultrasound picture of my heart. This would allow us to see exactly how ...
Read more

My First Week: 2 South psych ward

Monday last week was orientation for clinical rotation on the psychiatry ward. It was exciting and intimidating all at the same time, especially the part about getting security keys, fingerprinted, and having to provide a urine sample for drug screening. It was a calm day regardless though, and there was no work with actual patients until Tuesday. Tuesday morning I made my way through the string of locked doors at Mid-Missouri Mental Health Center (hereout referred to as Mid-MO), the mental health hospital. I am assigned to the ward on 2 south. I met the psych resident assigned to the floor, Dr. Johnson (not his real name of course), and discovered I and the other two medical students assigned to the floor would accompany him to the county courthouse to start the day. Dr. Johnson had to take the stand to testify to the need for inpatient treatment for a number of mentally ill individuals who were picked up by the law. It was an interesting start to the day. After court hearings we hurr...
Read more