Pulmonology, Week 1, Day 5

The last day of my pulmonology rotation...this week has gone by so fast and I have learned so much in this short period of time.

For the last day of our rotation, we joined Dr. Chieng (from Monday) once again on his morning rounds. Most of the patients we saw on Monday had been discharged and a few more had been admitted. Before going to see the patients, we looked at their lab results and chest x-rays. For those patients who were still in the hospital since Monday, we followed their disease progression.

The hospital is a fascinating place; while one patient may progress to a decreased state of health, another may experience disease resolution. It is where one can observe the juxtaposition of life and death. That was the case for 2 of the patients we saw. Both patients had been in the ward on Monday, so we saw them for a second time. The first patient had a PMH of diabetes mellitus type 2, chronic kidney disease, and coronary artery disease, and an old cerebrovascular accident. He was admitted for pneumonia and his sputum culture revealed infection by Pseudomonas aeruginosa. After 14 days of treatment with ceftazidime and levofloxacin, he demonstrated a clinical recovery. Because his CXR still appeared a bit hazy, Dr. Chieng considered prescribing oral antibiotics. However, after consulting with his PA, he decided not to prescribe them. Upon seeing this patient, I could see that he had improved since Monday and that his family seemed happy to hear that he would be discharged today. In stark contrast with this patient, the next one we saw was experiencing a progression of his disease. The second patient had a PMH of diabetes mellitus type 2. He was admitted to the hospital for acute exacerbation of terminal COPD and he had chronic respiratory failure. He was on BIPAP (bilevel positive airway pressure), which is a continuous airway pressure system with either a time-cycled or flow-cycled change of the applied pressure level. He had developed drug-resistant healthcare associated pneumonia (oxacillin resistant Staphylococcus auerus= ORSA and extensively drug resistant Acinetobacter baumannii=XDRAB), so he was treated with ceftazidime, and then with meropenem. On 6/10 the patient attempted suicide. Upon examining this patient, Dr. Chieng told us that the patient was probably losing consciousness, possibly due to carbon dioxide retention. We could see that the patient was not doing well and that his disease was progressing.

This past week has given me a a chance to put my pre-clinical knowledge to the test and to see how clinical medicine is practiced. It was great to see how doctors approached a diagnosis and treatment of a patient. Patients enter the hospital with the hope of getting better, but now I have seen the reality that disease resolution does not always occur, despite the best efforts of the medical staff. My experiences this week have given me a better idea of what is involved in the art and science of medical practice and I am grateful for all the time that Dr. Chieng, Dr. Huang, Dr. Yu, Ms. Eva Chang, and Dr. Lin spent with Arthur and me.