Night nurses
Night float. I got called on a patient, one of my cross-covers that I know well after spending an hour trying to establish code status and avoid intubation the other night. Nice guy, has AIDS, has a nasty probably-pneumocystis pneumonia. Nurse calls me to tell me he's hallucinating. Seeing angels or beasts or some such, and he's overcome by the need to preach the Word of God to everyone who comes in the room. New behavior - this man had no interest in evangelizing to me while I was putting him on BiPap the other night.
What labs do you order for acute hallucinations? He's been in the hospital far too long for it to be DT's; he's not much of a drinker anyway. So I got a basic met (that's an electrolyte panel) and an arterial blood gas. They came back with a bit of an alkalosis and a bit of worsening renal function. So I gave him fluids - half a liter over an hour, not a whole lot, really, just enough to feel like we were making some difference. And to be honest, I only gave him half a liter because I'd had to diurese him two nights before so I wasn't sure about the whole liter, even with a stable cardiac status. I didn't anticipate this was going to change anything.
The nurse just called me back to tell me that his visions had stopped, post-fluid bolus. "He's sitting in there contemplating what he saw..."
We've been talking with the folks with the Latter-Day Saints recently, for various reasons, one of which is theological curiosity. So visions are on my mind; and our response to things we don't understand.
I wonder, I said, if I just interrupted a religious experience. But it seems that God wouldn't be stopped by a bit of normal saline.
"No," says the nurse, just as serious. "I think God would require lactated ringer's at least."
This, O Best Beloved, is quite possibly the funniest thing I have heard in days. And I had to tell you, because some of you will understand.
What labs do you order for acute hallucinations? He's been in the hospital far too long for it to be DT's; he's not much of a drinker anyway. So I got a basic met (that's an electrolyte panel) and an arterial blood gas. They came back with a bit of an alkalosis and a bit of worsening renal function. So I gave him fluids - half a liter over an hour, not a whole lot, really, just enough to feel like we were making some difference. And to be honest, I only gave him half a liter because I'd had to diurese him two nights before so I wasn't sure about the whole liter, even with a stable cardiac status. I didn't anticipate this was going to change anything.
The nurse just called me back to tell me that his visions had stopped, post-fluid bolus. "He's sitting in there contemplating what he saw..."
We've been talking with the folks with the Latter-Day Saints recently, for various reasons, one of which is theological curiosity. So visions are on my mind; and our response to things we don't understand.
I wonder, I said, if I just interrupted a religious experience. But it seems that God wouldn't be stopped by a bit of normal saline.
"No," says the nurse, just as serious. "I think God would require lactated ringer's at least."
This, O Best Beloved, is quite possibly the funniest thing I have heard in days. And I had to tell you, because some of you will understand.