Saturday, July 3, 2010

Week 3 - Carissa

This week I had the opportunity to shadow doctors in the Medical Intensive Care Unit. It was a very eye opening experience for me because up until this point most patients I have seen have been dealing with visible deformities or wounds. In the MICU patients come in from other departments (ER, other hospital wards) in unstable states (heart arrhythmias, host vs. graft problems, out of control blood clotting, impending kidney failure, unexplained swelling), and the doctors try to stabilize and treat them. Here at NYP, there are 20 beds in the MICU, one attending physician and a team of residents and fellows are responsible for caring for half of them.

One case that struck a rather personal chord was a woman who was struggling with host vs. graft disease. A while back she had received a bone marrow transplant as part of a series of cancer therapies. The bone marrow came from a different person, and now, despite immunosuppressant drugs used to control graft rejection, her skin and mucous membranes were getting destroyed as a result of the presence of the graft. Graft vs host had also caused multiple pulmonary embolisms, she had begun to retain a lot of fluid despite the diuretics she was taking. There were concerns that her heart and kidneys might not be functioning properly. On top of all of that, she wasn't eating much any more because she felt so terrible, so the doctors had to put her on total parenteral nutrition (feeding via IV drip). The doctors were trying to help her feel better, but in all reality she will probably succumb to her graft vs host disease shortly. My heart goes out to her and her family as they are forced to begin making all the decisions that go along with such a difficult situation. I also admire the fortitude the doctors must have in order to treat such ill patients everyday with such uncertain prognoses.

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