Sunday, May 25, 2008

Suicidal Patients

I've been at the county hospital for a month and a half now. And even though I've seen patients come in who have attempted suicide, I've seen way more in the past month and half than I have my entire third year of medical school. I don't know if this is a direct result of being in the county hospital or not - I just know the numbers I have seen.

I had a patient this past week who ingested, intentionally, way too much Tylenol. Acetaminophen (Tylenol) is toxic to the liver when you get over 7,000mg. This patient presented to the hospital after ingesting - drum roll please - 25,000mg! Unbelievable! Can you imagine how bad life must have been in order to do this? Oh, and if that wasn't enough, throw in quite a bit of EtOH (that's how doctors write alcohol....we're so smart!) - which is another toxic agent to the liver.

We saved the patient's life - and, subsequently, transferred the patient to the psych ward. My guess is that I will see this patient again before my time is done at the county hospital.

I had another patient this week who presented with acute pancreatitis. Apparently the patient had been drinking about a gallon of vodka the few days leading up to the current attack. Of special note - the patient was also a chronic drug seeker. My favorite. And wouldn't you know...pain control is one of the top managements of pancreatitis? Yep.

The patient was also newly homeless.

While most patients only need a few days in the hospital to get the pancreas back to "normal", this patient seemed to like the hospital and stayed about 6 days. No surprise to me...or the resident...or the attending....when we learned that the patient was taking smoke breaks during the day and bringing back dirty laundry that needed to be washed. And when we told the patient that we were planning to discharge, the patient actually said, "Well, I have some phone calls I need to make. Maybe tomorrow would be better."

I saw the patient a few days after discharge, sleeping in a car in the hospital parking lot. Looked like there was freshly cleaned laundry in there too.

I'm guessing there might be another "pancreatic attack" before I'm through.

On another note, please take a look at "Ah Yes, Residency". This post is awesome - and please note "The Shadow" which sums up my medical student experience!

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