"Obstetrics" at Rex

As I thought, the most obstetrics experience I'll probably get this week is a tour of the birth center. Oh well - the other cases this RD sees are all over the map, which has made things interesting.

One interesting case: 60-70 yo woman who is bed-bound end-stage MS. She was doing alright at home with family taking care of her, but she came to the hospital last week with pneumonia and severe nausea. During a chest x-ray, the doctors discovered a hiatal hernia - 75% of her stomach was in her chest. She was put on clear liquids, but she wasn't eating anything. She hadn't been eating at home for a while, either, so her alb was already low upon admission. We didn't get a consult to see her until she had been on clear liquids for 5 days, at which point they were still debating what to do. They were leaning towards surgery to repair the hernia the next day. I felt pretty powerless at the time, but I think I may have helped: they actually took my recommendation (or maybe the MD thought of it himself, but I'll pretend it was me) to measure her alb or PAB. The the MD saw that her PAB was 5, so he postponed the surgery to start TPN and make sure she's strong enough for the surgery.

End-of-life issues continue to be important. We also got a consult for a severely demented 84 yo woman who can no longer eat anything without aspirating. ST had to suction the food out of her mouth during the swallow eval after they realized she didn't know what to do with it. Basically, she either needs a PEG or to be placed on comfort care/DNR, but the family can't decide what to do.

Apparently Rex has quite the international clientele: I did an instruct last week with a hilarious German man and an instruct this week with the most adorable British couple. They were in their late 70's but full of life and love.