Things We Don't Know

It's easy to diagnose, treat, manage, write about, and describe things we know well. The majority of clinical situations, cases, patients, and procedures described in this blog are ones I feel very familiar and comfortable with. But perhaps the point of training is to learn about and become better at those clinical situations, cases, patients, and procedures which intimidate us. As an anesthesiologist, I feel well-versed in many things, but one of the clinical scenarios that scares me most is the hematology patient.

One reason the Stanford medical ICU is much higher acuity than the other ICUs we rotate through is the high prevalence of patients with bone marrow transplants, graft versus host disease, acute leukemia, tumor lysis syndrome, and serious reactions to antineoplastic agents. These are disease states we almost never see in anesthesia, so I rely heavily on my medicine colleagues, my consultants, and my reading to give me guidance. These patients can be incredibly sick and though I can manage supportive care - the vasopressors, dialysis, mechanical ventilation, antibiotics, transfusions - I don't know the hematology very well. This makes it hard for me to estimate prognosis, talk at family meetings, decide on when to pursue chemotherapy, and identify side effects of antineoplastic agents. As a result, it'll be a personal focus the next few months for me to gain a better understanding of hematologic illness and disease courses.

Image of acute myelogenous leukemia blood smear shown under Creative Commons Attribution Share-Alike License, from Wikipedia.