Last Call at the VA

On my last call at the VA, I admitted a handful of fairly interesting patients. My first was a direct admit from infectious disease clinic for the first use of doripenem in the VA system. Though clinic admits like this are often less educational because they are consult-driven (ID has already determined the patient's antibiotic regimen), I liked this because I used to work on Pseudomonas research, and that was the unfortunate microorganism involved. It's fairly impressive that the ID attending managed to secure a new expensive antibiotic for this gentleman because I've found non-formulary requests at the VA to be hard to push through.

I also admitted two patients with refractory angina; they were having concerning chest pain with minimal exertion. Normally, I know what to do with angina. But one of the patients had been revascularized so many times that cardiologists have said that he has no more targets for stents or bypasses. What do we do now? It was an educational experience to learn about interventions such as ranolazine, external counterpulsation, and spinal blocks as symptomatic therapies for these patients.

Finally, I admitted a patient with acute on chronic renal failure where we couldn't figure out the patient's volume status. Should we give him fluids? Should we give him lasix? He had history and exam findings that could go either way, and it was educational to see how an attending approached this case.

Overall, I was happy to be done with another month of call. With time, calls get a little easier. Now I have become efficient enough to get at least some sleep each night, even if I'm cross-covering or have sick patients. So it's not quite as rough as it used to be.