Wednesday, April 06, 2005

My First Diagnosis

Guess what: I made my first diagnosis today! I'm serious, it was a real diagnosis. We have a patient in the ICU, and we didn't know what to do (hey, that rhymes). We have this software called Diagnosis Pro where we can put in some symptoms and check out the differential. OK, so we put in some info and the comp kept saying he had a diabetic coma (no, the guy was talking) and cancer (ok, we already thought that, but the CT scan kept coming up negative). One thing about this patient was that he had acetone in his blood (and no, you're not supposed to have nail polish remover in your blood). We checked out the differential some more and one possibility was chronic alcoholism (ding ding ding!). When alcoholism is suspected, the patient is automatically given Thiamine. The doctor went ahead and wrote that order and moved on while one of the patient's other doctors said that he had no idea what was going on with this guy.

As we were walking away to another building I said, "Doesn't acetone build up through ketosis?" and my doc said yeah and I said, "Well, ketosis occurs during fasting. So if our patient has acetone in his blood, he must be starving." My doctor said, well I checked his Hemoglobin A1C and it was normal. I said, "But our patient is an alcoholic...didn't you say that he looked 'emaciated and wasting'?" Yeah, he said. I said, "then maybe he's not eating at all, just drinking. He's choosing alcohol over food. His alcohol is depleting his niacin and he doesn't have enough niacin for the Krebs cycle. So now he has sugar in his body, but he can't metabolize it. Since he can't metabolize glucose, his body is going through ketosis since he's fasting. How much acetone was in his blood?" My doc said, "A very small amount...but there shouldn't be any at all. That's why it's a big problem." "So," I said, "that means that he's in the second, not the third, stage of fasting. We can still help him. Shouldn't we give him niacin?" "You're right, Maryam!" he said, "We have to give him Thiamine first to save his brain and then Niacin to save his body. I'll let the orders stand because if I go back and write for Niacin too they'll give it to him in the wrong order. But I'll go back later today and write for Niacin. Great job!"

I was sooo happy! I really can be a doctor. I do have the qualities that make a good physician: breadth of knowledge + analytic reasoning + critical thinking (+ compassion). I have to do well on my MCAT so that I can show the admission commitees that I do have what it takes, and I can finally begin the career that I was born to do.

5 comments:

drhaibane said...

oh man wowww! i think you have the skills needed to be a really good doctor. you also have compassion, a trait that seems to be given less and less importance as the human body is seen as more so of an orthopedic, biological machine and less so of a person.

congratulations on your first diagnosis! be sure to ask me and i'll tell you about my friend, carissa, who also did her first diagnosis in college as ketosis, and saved a person's life.

Sreekesh Menon said...

" We have a patient in the ICU, and we didn't know what to do .." sounds reassuring . :-) lol!

Barbara said...
This comment has been removed by a blog administrator.
Anonymous said...

whoops.. i published the comment from my girlfriend's thing.. d'oh.

Anonymous said...

thanks for sharing the story, maryam. glad to hear things are going well for you. i havent been by here in awhile but it seems like you're on top of it... mcats and all.

cuidate (take care).
- gp