After thoughts...

Alcoholic and IVDU are two of most distinct groups of patients who present huge challenges - clinically and socially. They are the people who need most helps, and yet are the most non-compliances, probably most aggressive and they have this love-hate relationships with the hospital staffs. I strongly suspect IVDU must have something in their genes - the addiction, the survival gene (you will be amazed how much they "come back" despite the thrombosis,the infection, the bleeding etc..) and probably most intelligent (medically speaking). Ever heard about the "skin poppers"? I mean the idea of creating an infection on the skin - stimulate blood vessels growth -hence new areas to inject when you run out of veins? That is genius, not to mention a healthy medium for all the bugs.

Yesterday, I had to console this upper middle class businessman. He misinterpreted what my seniors said and thought he can self-discharge. There is no way in hell I am discharging him - Child Pugh C with alcoholic hepatitis; and I will drag the psychiatrist/use the law or police if I have to. First hospital admission, and we just managed to get him out of his encephalopathy and sepsis. In his own word, "I am a condemned man". That is an absolute truth, and I don't think his liver will ever recover (still scoring C despite all we did). Only time will tell, and we are entering a 3rd week here. His pre-operative risk is in excess of at least 70%. I literally brought him back down to earth; and I hope he realise the enormousity of the damage to his liver. I feel sorry for the children.

On-call was fine yesterday; very busy and we accept plenty of interesting cases. I really had to sit down and think and work out the diagnosis for this jaundice patient. The jigsaw doesn't really sit together.Interesting to know what is the final verdict.

Apart from that, can't wait for Paris! Shhh, not really telling anyone at work, its so damned difficult to get leave from this crazy rota.When I come back, it will be hell anyway.