IC is not infallible

This week was my medical ICU rotation, ie, the very sick and dying. I got to see a metabolic cart study for a lady who was about 45 kg and 77 years old. I didn't assess the patient, but I think she was at then end stages of cancer with multiple complications and was immobilized in bed. The first study they did on her showed an REE of 6100. We told the MD about the results, who responded "Well, load her up!" My RD explained that it would not be possible to give this little old lady so many calories and that there was almost no way this was correct. So the MD agreed to order a second study, which showed an REE of 1900. Although I was surprised by the MD's response, I also felt like it validated the need for RDs and the unique clinical expertise that dietitians have.

We also ran across a patient we saw three weeks ago when we were on our renal rotation. She is now in the MICU waiting for a liver transplant. Her case is particularly sad because she is a 40 year old teacher who has just had really bad luck with her health. Right now she has serious jaundice, and I have never seen a person that shade of yellow. They think she has developed hepatorenal syndrome, so she is also on CVVHD. There was a chance for a liver transplant on Thursday night, but the liver wasn't good, so it fell through. I'm keeping my fingers crossed.

The big news for this week, though, is that I got a dog! She is a 2-year-old terrier mix with a great personality. I'm looking forward to introducing you all to her when you get back to CH!