Halfway through third year and I don’t feel like I know all that much more now than I did before I started this rotation. But I like to think that I absorbed more than I think.

Dr. R at Einstein was impressed by us. Unfortunately, we only worked with him for one day. Dr. D thought we were idiots and looked at us with a condescending flutter of her eyelashes, though she was oddly perky today. The other Dr. D didn’t give us the time of day. Dr. B was busy. Dr. H thought I was stupid for believing the drug-seeking guy. Dr. N is a genius. Dr. S was a sweetheart. A lot of them just thought we were idiots. 

Most memorable: 65yo M with h/o MI, s/p cardiac arrest found face down in a cafe, now in comatose state likely 2/2 anoxic brain injury. From what I could see from the outset, he looked to be in a deep sleep. He had + corneal reflex, pupillary response, Doll’s eyes, and pronounced withdrawal from pain in lower extremities. He was overbreathing the vent and made occasional yawn-like mouthing movements. But he’s also 9 days into it with worsening babinski and few signs of improvement. He is likely in a permanent vegetative state. The son visits often, and tries talking to him without much effect while I was there. The family is Albanian, very close-knit. They are at the beginning of family meetings to discuss withdrawing life support. 

It’s difficult to let go of a loved one, especially when you have control over when. But is there really ever a “right” time?

Along the same vein: a man develops Pick’s disease. As his dementia progresses, he becomes more belligerent, especially towards his wife. Wife cannot bring herself to institutionalize him, she still loves him. But he is no longer who he was. His frontotemporal lobe degeneration has made sure of that. After another incident of battery, social services takes over due to concern for her safety. Luckily for her, the decision is no longer hers. He is institutionalized.