Monthly Archives: January 2012

a patient is in hawaii. about 6 months ago, he starts developing deep vein thromboses (clots that form in legs). he gets started on anticoagulation with warfarin. unfortunately he fails that because he also has ulcerative colitis, so he bleeds too easily. he gets a IVC filter placed. (it’s a little metal thing that goes in your vessels and prevents clots.) a few months after, he clots, multiple times, in his lungs, in his legs. he is hospitalized, and started on heparin. he has an allergic reaction to it, so it cannot be used. he is started on argatroban. since it’s a continuous drip, he has to be in the hospital all the time for the argatroban. they try to switch him back to warfarin because that can be taken orally. he is discharged. he returns quickly and he has developed more clots. he is hospitalized again and is on argatroban again. they try to transition down many times, but each time to no avail. by now, he’s had so many clots and stuff that he’s lost a hand, multiple fingers on his remaining hand, all the toes on one foot, and 2/5 toes on the other foot. 3 months in the hospital, he decides to leave. the hospital gives him a big dose of anticoagulant. he gets on an airplane immediately and flies over to california. comes to the hospital. he comes with about 500 pages of records (which are very messy, and mostly handwritten [ugh, doctors’ handwriting]). he’s been off anticoagulation for about 24 hours and one of his arms turned blue already. an imaging study shows that most of his veins have clots in them and are partially blocked. when the morning comes, we scramble to get anticoagulation as soon as possible for him. hematology, vasculatory, and medicine team are all working through his pages and pages of charts. we go see how he is. he complains there is no internet. he’s considering going to another hospital.

best chief complaint from patient: “money, i want to make $2000.”
past medical history: schizophrenia, hepatic encephalopathy.
oh….

scabies is definitely more scary than MRSA. had a patient with scabies. (they are little bugs that crawl under your skin and reproduce like crazy and cause crazy itching.) patient was put in contact isolation just like a MRSA patient. whenever we go check patients, the doctors and stuff don’t care so much about MRSA. just hang the gown, don’t even really tie it on, walk in. but when it’s scabies, make sure gown is covering everything, gloves. when taking off, make sure the outside isn’t contacted. so scary. itchy itchy.

i was driving back from the hospital today and i noticed quite a few police pulling speeding cars over. pharmacy is a lot like police. we check orders, make sure that the doctor didn’t write the wrong dose, wrong drug, wrong patient (yes, it happens), wrong quantity, wrong something. maybe patient is allergic, maybe patient cannot afford, maybe insurance doesn’t cover. a bunch of things can go wrong, pharmacist make sure things are correct. in the hospital, we check if drugs in the correct material bags, correct solvent. we check if there’s even an indication for the drug, check to see if the doctors are following guidelines for their prescribing. hopefully they aren’t just pushing the drug that the drug representative convinced them to use over a fancy dinner. we see the refill history, we know what drugs the patient has actually picked up. we make sure that the patient tries certain drugs before trying to the expensive new alternatives. so like the police, we stop incidents before they can get worse, keep the system safer, and more affordable. too bad no one likes cops.