Saturday, November 24, 2012

Of waltzes and wits...

Posted by Unknown at Saturday, November 24, 2012

I’m engulfed in the fumes of the pastel green goop I have just smeared all over my hands and wrists. The familiar coolness of the iconic hospital hand sanitizer washes over my skin, which is just beginning to display the telltale signs of the start of a harsh Michigan winter. A stinging sensation briefly causes me to pause and look down—a new paper cut I hadn’t seen, probably obtained just minutes before when I was shuffling through my patient monitoring forms, scrambling to copy down hot-off-the-press bacterial cultures for one of the patients I was about to round on. I welcomed the stinging, and made sure to work the last traces of hand sanitizer into the cut in the few seconds before they vaporized from my now bacteria-free hands.

You see, this procedure is not uncommon on rounds, it’s the protocol—sanitize in, sanitize out—as we visit each and every patient’s room. While this rotation, Infectious Disease with Dr. Carver, was not my first rotation rounding, the precautions meant so much more to me now. I am gaining a new appreciation for the world of the unseen, a world in which—invisible to the naked eye—bacteria specialize in ravaging the lives of perfectly healthy individuals within weeks, days, even hours. I began to slowly see the pages of my therapeutic notes come to life in front of my eyes. I’d find myself thinking, ‘Aha! Cellulitis. So that’s what it looks like!’

But seeing the patients themselves does not actually comprise the bulk of this rotation. Our daily routine begins with us (my colleagues Tony Elias, Mary Lou Chheng, and I) working up our own patients in the morning, where we assess all aspects of a patient’s antibiotic therapy: indication, dose, allergies, cultures and sensitivities, toxicity. I find this part both challenging and enjoyable. As I pore over the pages of Dr. Carver’s infamous bug drug list, I feel like I am engaged in nothing short of a battle of wits, reading an instruction manual listing all the strengths and weaknesses of my opponents, choosing the best strategy to outsmart them. We then meet with Dr. Carver to discuss our patients and make any necessary recommendations to the medical ID consult team. On rounding days we make the recommendations in person, and on non-rounding days we send our recommendations to the team electronically. The remainder of our day involves extensively reviewing with Dr. Carver the ID topics that are pertinent to our patients.

On a personal level, this rotation is also hitting close to home, as I realized the widespread implications of infection. For example, after seeing cases of patients acquiring infections after recent placement of prostheses the knee replacement surgery I had been encouraging my father to consider because of his increasingly intolerable osteoarthritis pain suddenly didn’t seem like such a good idea anymore. I finally understood why he is holding off on surgery as long as he can. Being a physician, he understands the risks of having foreign hardware in the body, a concept I only just began to internalize as a newbie in the healthcare profession.

And thus is my experience with ID so far. ID, which I have come to see as a delicate waltz, sometimes clinicians leading the dance, sometimes the bacteria, one always struggling to gain footing over the other. 

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