Midnight Crisis: Resolving a Patient's Distress

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“Whoa-oa-oa! I feel good, I knew that I would now. I feel good….”. My “I feel good” ringtone woke me up from the depths of slumber during my first night call in internal medicine rotation. My supervising intern instructed me to come to the 4th floor for a patient in distress. Within moments, I scuttled through the hospital hallways and on to the stairs finally arriving short of breath at the nurses’ station. Mr. “Smith”, a 60 year old male with a past medical history of COPD was in respiratory distress. He had been bed bound for the past week due to his severe arthritis and had undergone a right knee replacement surgery the day before. During evening rounds earlier, he had no signs of distress. However, now at 2 AM in the morning, only hours later since rounds, he was minimally responsive. My intern and I quickly obtained the patient’s ABG measurements and subsequently initiated a trial of BIPAP. This resolved Mr. Smith’s respiratory distress and abnormal ABG values. To rule out serious causes of dyspnea, a stat chest x-ray and CT were obtained. Thankfully, both studies came back normal. …show more content…

I like problem solving and the challenge of being faced with a set of symptoms to figure out the diagnosis. With my preceptors, I experienced the intricate thought processes involved in managing patients with multiple co-morbidities. Going to my clerkship everyday was exciting in not knowing what I will encounter; it can be an acute or chronic condition or a combination involving any system of the body. At times, I also observed my preceptor play an initial role of a specialist such as a cardiologist or nephrologist. I respect the vast knowledge internists possess and their integration into practice. During my clerkship, I felt like every day was an adventure of problem solving which is appealing to me as a

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