celeb doctors and a date with an inmate

This week is turning out to be an interesting one... Since I do not have rotations at my small hospital, I have been attending ICU rounds daily. The ICU at Cayuga Medical Center keeps me entertained with the many different attending's they have. There hasn't been a permanent intensivist there in 2-3 yrs Ive been told. So there are 4 regular temps that come in from NYC and Syracuse for 4-5 days straight. It's been a really good learning experience though because I get to hear each doctor's opinion on things like residuals, serum albumin and IV albumin, and other controversial ICU topics. I imagine it is a bit more frustrating for the nursing staff as they have to adjust to each new attending's style constantly. For today and tomorrow there is a "substitute" attending here. His name is Paul Marino and he is THE ICU Dr. He wrote a very well-known text "The ICU Book" that I have seen frequently on the shelves in the ICU. Today's rounds took nearly 45 mins to talk about only 10 patients or so because Dr. Marino was explaining a lot of interesting things about HCl in the stomach and its purpose, mouth hygiene, residuals, etc. I could tell some of the other staff was getting antsy because they have a lot of other things to do, but everyone was eager to hear what he had to say.

Also today, I have been following up with an inmate who is here (with two guards and shackled to the bed). He's being treated for hepatic encephalopathy, with an ammonia level of 233! I was given the opportunity to break the news to him that the MD had ordered a protein restriction. He was not happy to say the least (and the slight deliriousness that he's experiencing certainly didn't help the situation). He was on a max of 75g pro/d (0.8g/kg) which is still fairly liberal. Nevertheless, it was still a challenge to cut the protein in his menu to half of what he had been ordering. I visited him again today and he seemed to have accepted the fact that he would have to limit his meat, egg and milk consumption for now at least. He did request that I personally come down to help him with his menu tomorrow, which I expect to be a hard bargaining session. I'm a little nervous. I'm bringing my exchange lists so I can at least show him the protein in the large portions of foods he orders. Should be fun!