Also within the warm walls of the clinic was a man who had been diagnosed with pneumonia this weekend in the ER. Fevers for 10days, lobar interstitial infiltrate, possible small effusion. Hospitalized for 3 days with IV Rocephin and went home on a Zpack. No biggie, right? Well the ER and the docs in the hospital seemed to have overlooked some major history and physical finding. This patient had esophageal cancer, had 90% of the esophagus removed and his stomach made into a pseudo esophagus and his colon and small bowel repositioned to accommodate the new stomach positioning. The entire procedure was performed abdominally. Shortly after this procedure, the distal end of the incision became red, hot and grew to a small ball which had to be drained as an abscess had formed underneath it all - healed up all better. Fast forward to this past weekend - patient goes to the ER for a cough and fevers but everyone seems to overlook the bright red bulge at the distal portion of the previous incision which coincidentally opened up after he was discharged began draining - cultures obtained - growing staph - waiting for sensitivity reports (probably MRSA my guess). The opened area is big enough to sick my finger in - I was tempted, but I didn't, you could see into the subdiaphragmatic area if you flashed a penlight at it, thankfully nothing waved back at me. Sent him off for immediate abd/chest CT and sure enough has a subdiaphragmatic abscess. Needless to say he will be seeing the surgeon who performed the original surgery like tomorrow.
My patient joy for the day: 45yr old male, overweight, uncontrolled DM - HgbA1C (the lab test that looks at how sugars have been controlled for the past 3 mo)was 10.3% (<6.5% is goal) and trying to watch his intake. His fasting sugars have come down from 160-200 to 120's. He said to me: I just take it one day at a time, I don't worry about what I am going to do tomorrow or next week, just focus on today - I can do it, I have to do. I shook his hand, shed a tear as I turned away to wash my hands and carried on with the exam.
There may not have been any congratulatory moments from my preceptor or patients for finding the elusive cervix or for maybe changing someone's life for the better but I know I should give myself props for both - something that I have a hard time doing. It was a reminder why I am becoming a PA - not an MD(a question I have struggled with during this journey) - I took the time, made the difference. It was a good day in clinic today and so with that I leave you with a few lines from my favorite Rock Opera of all time - RENT:
"There's only us
There's only this
Forget regret - or life is yours to miss.
No other road
No other way
No day but today"
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