First day in the ICU. Another fun game of guess what I’m thinking between me and the attending…
I began…
Me: “Dr. Scott, did you get a chance to look at Mr. Ziek’s numbers?”
Him: “I did, did you?”
Me: “Yep.”
Him: “What did you think of them?”
Me: “Well, his pulmonary artery pressures are high, his central venous pressure is high and his wedge pressure is twice normal.”
Him: “So you’re saying he’s fluid overloaded?”
Me: “Yes, that’s what I meant to say.”
Him: “What kind of fluid overloaded is he?”
Me: “huh?”
Him: “There are two kinds of fluid overload…”
Me: “Can I say right and left?”
Him: Rolls his eyes.
Me: “How about too much in, and not enough out?”
Him: Shakes his head in mock disbelief. “No. Cardiogenic and non-cardiogenic”
Me: “Oh. Well then it’s non-cardiogenic. His heart is pumping fine.”
Silence.
Him: “So what do you think of his oxygenation?”
Me: “It’s crappy.”
Silence.
Him: “See this line here where I write my diagnostic impression? If I write ‘crappy’, I don’t think I’ll get paid.”
Me: “Hmm.”
Him: “So what is it?”
Me: “Well, he’s got plenty of hemoglobin, his blood pressure is fine, and his cardiac output is adequate.”
Him: “So then you’re saying he’s got a primary pulmonary process?”
Me: “Yes, that’s what I was getting around to.”
Silence.
Me: “What about his fluids?”
Him: “Stop them.”
Me: “He’s still fluid overloaded, can I give him some Lasix?.”
Him: “Give him a small dose.”
Me: “Forty?”
Him: “A small dose.”
Me: “Twenty?”
Him: “I said a small dose. Give him ten. You can’t take it out, but we can always give more.”
Me (doubting that 10 mg of Lasix in a man who is 9 liters ahead is going to make any difference) “Well, we can always pour more fluid into him as well.”
Silence.
Me: Smile.
Him: Smile.
Silence.
