Infectious diseases.

Today I shadowed the hospital's lone infectious disease specialist. Since I took a microbiology course last semester, today was the first time I've been able to follow most of the discussions between the doctor and residents. MRSA, VRE, KPC - it was nice to know what all those mean.

The first patient of the day was a 19-year old guy with recurrent MRSA infections on his face, arms, and legs. The treatment, unfortunately, simply consisted of telling the guy to shower more frequently and keep his skin moisturized, as well as use an antibiotic cream when he first notices a flare-up, followed by oral antibiotics for 10 days. The poor kid will probably always get infections, as some people are simply more prone to growing resistant strains of staph.

In the ICU we saw a 69-year old woman with MRSA endocarditis, probably due to infection of the stents recently placed in her arteries to keep them open. She was a rather sad case.

The most exciting case of all was a 29-year old who has been in the ICU for at least two weeks (at least, that's when I last noticed her there) who was confirmed to have an infection with KPC (Klebsiella pneumoniae carbapenemase) - a highly drug resistant form of Enterobacter cloacae ("Eats through walls" is how the doctor phrased it) which required her to be moved from the bay into an isolation room. Isolation isn't so uncommon as shows like House make it seem - probably at least half of the ICU/CCU patients here are on isolation restrictions, though compliance with the restrictions (particularly among the staff) is an ongoing problem. Anyway, I was thrilled to watch this case unfold, since my final project in micro last semester dealt with KPCs and how they're treated.

The classic conflict between medicine and surgery reared its ugly head again this afternoon when we visited a woman with squamous cell carcinoma of the hand. The surgeons have already removed some of her fingers but the underlying osteomyelitis has spread upward, and all the internists say that she needs the hand and about half of her forearm amputated. The surgeons had thus far refused to deal with the case, and the poor woman is so out of it because of her treatment that she has no idea that she will die very soon if she doesn't have the surgery. Apparently the ID doc I was with today has been screaming for days to get this woman into the OR, and finally this afternoon a surgeon from orthopedics came by her room to do a consult; the surgery is scheduled for later today. The case only confirms what I've noticed in every specialty: everyone who is not a surgeon hates the surgeons, and the surgeons don't really care. My first OR days are next week, and I'm curious to see how this conflict will appear from the other side of the fence.