The ER finally woke up and sent us two alcoholic patients: one for detox, the other with cirrhosis, ascites, and hepatic encephalopathy. (They also kindly neglected to draw labs on the encephalopathic patient, which leaves us flailing a bit helplessly, because it’s contrary to our modern reflexes to make decisions or prescriptions without lab numbers. Even though the guy is patently sick.)

His skin and eyes are yellow, and his hand are shaky. He started off whispering, I think in order to get me closer to him, but finally progressed to a hoarse croak in frustration at my lack of mind-reading skills.


The blog and I are having, apparently, even more trouble understanding each other. There was a whole splendid description of how he kept trying to get closer and closer, and I kept trying to find the way back to the door, and how he bothered the resident too, but since this isn’t an official history I don’t have the motivation to type it up again.

The interesting part was when we decided he needed paracentesis (needle in peritoneal space to withdraw fluid) to relieve the ascites, and find out what the exact cause was, and if there was any infection. The resident generously agreed to let me do it. All the while we were setting up, he was trying to hold our hands, promising to be “very compliant,” but also insisting that we not hurt him at all. Then, when we actually got down to it, he became very jumpy and nervous, and the resident had to order him very firmly not to talk. That didn’t keep him from making a vast commotion when I was trying to inject the lidocaine; and between him squirming, and the resident over my shoulder insisting that I put it just under the skin, no deeper at first, it took me a couple of tries just to get that needle done. This, by the way, from an iv drug user. Then there was the big needle with the catheter, to withdraw fluid. I got it through the skin, and felt it punch through some kind of resistance, which I figured for the muscle wall, and didn’t dare push much farther. (Earlier in the day the resident had met the surgeon who had assisted in downward course of the patient who got a punctured colon when a different resident did paracentesis on him, and who ended up with peritonitis, emergency surgery, and death. So I was feeling gingery about getting the needle anywhere close to this guy’s intestines.)

The resident had to take over, and pretty soon hit the spot, and started withdrawing fluid. But the guy wiggled so, we weren’t able to get much, just enough for some basic tests, not enough to be really therapeutic. But I was satisfied. Not a completely successful procedure on my part, but on the other hand I didn’t injure the guy. I’ll settle for that for now.