Silver lining?
I'm feeling good now.
Maybe woke up on the wrong side of the bed. And have been grumpy for the less couple of days. But I guess things are going well today.
Saw patients at clinic today. In one of them about to undergo surgery, heard a loud late-peaking systolic murmur. My attending thought it was just age-related. But I pushed for an echo. "Severe aortic stenosis, valve area 0.7cm2." Cancelled the surgery; he's probably gonna need a valve replacement first. Or he could have gotten into real trouble in the OR.
Another patient. History of asymptomatic CAD, picked up incidentally and underwent a 5 vessel bypass 9 years ago. No stress test since. Didn't like his story. And he was due to have a carotid endarterectomy. Decided to stress him with a dobutamine stress echo. Came back as positive for ischemia, low ischemic threshold of 74 beats/min. High filling pressures. The cardiologist estimated his risk of a cardiac event on the operating table to be 80%. Postponed his surgery as well, until he gets an angiogram. He would have had a heart attack on the table.
And then, a med student from Germany whom I worked with last year emailed me. She was turned down for a position here. She's devastated. USMLE of 99. And she's good too. So I emailed my program director to put in a good word for her. And he was surprised. As it turned out, they did want to interview her, but she got a letter of rejection by accident. So, they rectified things, and she's coming in January for interviews. And she's happy.
Perhaps the day isn't too bad for me, after all.
I feel good.
Maybe woke up on the wrong side of the bed. And have been grumpy for the less couple of days. But I guess things are going well today.
Saw patients at clinic today. In one of them about to undergo surgery, heard a loud late-peaking systolic murmur. My attending thought it was just age-related. But I pushed for an echo. "Severe aortic stenosis, valve area 0.7cm2." Cancelled the surgery; he's probably gonna need a valve replacement first. Or he could have gotten into real trouble in the OR.
Another patient. History of asymptomatic CAD, picked up incidentally and underwent a 5 vessel bypass 9 years ago. No stress test since. Didn't like his story. And he was due to have a carotid endarterectomy. Decided to stress him with a dobutamine stress echo. Came back as positive for ischemia, low ischemic threshold of 74 beats/min. High filling pressures. The cardiologist estimated his risk of a cardiac event on the operating table to be 80%. Postponed his surgery as well, until he gets an angiogram. He would have had a heart attack on the table.
And then, a med student from Germany whom I worked with last year emailed me. She was turned down for a position here. She's devastated. USMLE of 99. And she's good too. So I emailed my program director to put in a good word for her. And he was surprised. As it turned out, they did want to interview her, but she got a letter of rejection by accident. So, they rectified things, and she's coming in January for interviews. And she's happy.
Perhaps the day isn't too bad for me, after all.
I feel good.
posted by vagus at 3:01 PM
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