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.

Learning Leadership

This past Thursday-Friday was the annual Internal Medicine Residency PGY-2 (means a second year resident) Leadership Retreat. At the retreat, we had several lectures, breakout discussion sessions, and role play practice in how to employ leadership skills that help foster a positive learning and working environment. The lecture and discussion series was led by facilitators who have been trained through the Stanford Faculty Development Center and utilizes their Clinical Teaching Program curriculum. The focus was for how we, as residents, can facilitate a positive learning environment for incoming interns and for medical students on the team. It also focused on how to set goals for an inpatient team, and how to best use your attending as a resource. Overall, it was a great retreat. Though many people think that some people are natural born leaders, I think many leadership qualities, if not most, can be learned and trained. Sometimes those who have had some kind of training or learning in...

Of Mice and Midbrains

It's just after 2 p.m., I've turned in my exam, but still have to wait around until 3:30 to do a 20 point section on neuroanatomy cross sections. I feel pretty good about the exam, I studied like crazy and I think it's all finally paid off. I should be studying cross sections, but I decided killing time was far more worth my while. And it lets me find really interesting stuff, such as this MC Hammer music video online. Since I'm just finishing a block on neurology, my first thought when watching Master Hammer dance was that he had bilateral hemiballismus , which is a problem caused by a lesion to the subthalamic nucleus in the brainstem. People with hemibalism tend to have wild erratic flailing movements because they've lost a part of the brainstem that helps suppress random movements. Is Hammer a medical case? You decide... In other news, I am flying out of Kansas City to head to Guatemala , for a one week medical mission. I'll spend four days working in a cli...

Lexington Square

Lexington Square Originally uploaded by Dr Peppers . Here's a shot of the courtyard inside my townhouse complex. Just one of a few of the photos I made with my new camera . Check out my photo feed here The rest of this weekend, however, will most likely be devoted to studying and taking practice quizzes. Hopefully, at least.

Rural Rounds

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