Crazy Christmas

Anytime I would tell someone I was working over the Christmas weekend they would always apologize. I don't know if they just didn't know what else to say or what. Truthfully it wasn't that big of a deal to me. As an adult Christmas just isn't as exciting as it used to be. It was fun as a kid but anymore it is just another day to me. It doesn't rank anywhere near the top of my favorite holidays. I much prefer Memorial day and Thanksgiving. At any rate, my attending was nice enough to let me have Christmas Eve off so Sarah and I were able to make it home Thursday night and spend some time with each of our families so it worked out pretty well.

The census at the hospital this weekend was pretty low truthfully but I stayed consistently busy and we had some weird stuff happen. Some of the highlights are below.

• Twenty-nine year old male with a history of Trisomy 21 (Down Syndrome) came in short of breath. He had no fever but did have an elevated white count at 18,000 and was breathing 40 to 50 times per minute. His percentage of oxygen in his blood was only 55 (normal is 80-100) on 100% oxygen. As a reference, normal atmospheric air that most people breathe is only 21% oxygen. His chest CT showed bilateral pneumonia and his left lung was approximately 80% filled with infiltrates. We ended up transferring him to Methodist so he would have better access to pulmonary specialists.
• A 72 year old female came in complaining of abdominal pain. CT showed evidence of free peritoneal air consistent with viscus perforation. She went to surgery overnight last night and was found to have a jejunal (part of the small bowel) perforation. I'd love to know how something like that happens. It's pretty much unheard of. Our surgeon, who has been practicing medicine longer than I've been alive, said this is only the second case he has ever seen.
• A 52 year old female who continues to have fevers and worsening chest x-rays with progressive dyspnea. There was a question of pulmonary embolism but her chest x-ray looks a lot like BOOP. I honestly don't know how common BOOP is but I've never seen a case before this weekend. On a side note, I have learned to take the obese middle age female cautiously. Their condition can seem to turn for the worse quickly. The last patient I saw like this had cellulitis from her foot to her naval and there was about a 6 hour period where I thought for sure she was going to get septic. The patient before that went from completely normal to dead in about 72 hours. She succumbed to strep-associated Toxic Shock Syndrome (which is actually pretty unusual). And no, it wasn't from a retained tampon.
• Saw a guy who I actually first met several months ago getting IV antibiotics to treat a variant of Pott's disease. The mycobacterium infecting his spine actually is not tuberculosis but some other species. He said he was only one of five ever documented to have this specific mycobacterium in the spine.

Hope everyone had a great Christmas holiday!