Page 25 - Volume 70 Number 2
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 with petechiae, bleeding gums, necrotic tonsils and only 2,000 platelets and 2,000 WBCs, 4% polys. Another was L. D., a 14-year old boy with an uncharacterized glycogen storage disease who was admitted with a blood glucose of 19 and went downhill despite IV glucose.
There was a free day mid-rotation when I went back to Boston City with Al Rozycki, my SAR, and showed him Peabody.
I saw Dick Garibaldi (who told me Mr. Santiago was doing well,) John McGowan, Wolf, and Al Cline. No nostalgia, though. The nurses on Peabody 2 gave me a present to deliver to GG1 for her birthday – a toy autographed dog. GG is going to be in a body cast for 2 months because of that spinal abscess that was Staph aureus chewing up L4. That little kid has had tough luck.
The girl with H. flu encephalitis recovered but had profound, bilateral hearing loss. The boy with atypical peritonitis improved for a short time, but then developed recurrent rash and fever along with congestive heart failure and pericarditis. “Mrs. S. was a marvel of faith and perseverance, and I acted as buffer, spending virtually all my time on the case.” He had convulsions and lapsed into a coma, had two cardiac arrests and was put onto a Bird (pressure controlled) ventilator, his pupils now dilated and unresponsive.
I started trying to regulate his blood gases that day. I was up till 5 AM before I decided he needed an Emerson volume regulated machine – and I discovered that knowing nothing but a few basic principles and having some common sense I was usually way ahead of the respiratory therapists. \[Later, while I took a 2-hour nap, one of the nurses changed the ventilator settings, which created a problem. It took some doing to restrain my anger.\] After 12 arterial blood gases we finally got him regulated and out of alkalosis. By this time, Mrs. S. was looking haggard and depressed, but hadn’t broken down yet. I talked with her frequently and tried to cheer her and relieve her anguish a little.
It began to become clear to me that I as making far too much on an emotional investment in this family and their child and that I was thereby both losing objectivity and wearing myself out physically and emotionally. ... I had to get away.
\[The next day, a Sunday\] I feel a lot better today having slept fitfully for most of yesterday afternoon, because of exhaustion more than worry, played bridge and drank beer last night with Lew and Kev at Bryan’s, slept well and had some exercise in the sun. I knew when I started this ordeal what I was getting into, but I wanted to experience it – I wanted to go overboard once so I won’t next time – with the freedom of a student, I knew I could shed the burden when it became too onerous. But the experience was there for the having and I wanted to have it, the experience of management of both child and family. I even drew up a resume of the respirator regulation so Al Rozycki, who is now our teaching resident, could make a worksheet for the other students to try their hands at running a respirator, at least on paper.
I am reminded by this that one must be involved in the action – one must take on the burdens to enjoy and learn this profession called medicine.
A.S.’sheartstoppedforthefourthandfinaltimethat >>
Volume 70 • Number 2 Washtenaw County Medical Society BULLETIN 25

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