Liver patients always intrigue me. Its amazing what kind of effect a failing liver has on the body. One of my patients today has End Stage Liver Disease (ESLD) and because of it, is completely jaundiced (to the point where his skin actually looks like its glowing, its so yellow), his abdomen is enormously distended, and he is encephalopathic (confused). Apparently overnight he pulled out his feeding tube that he had inserted thru his nose (a Dobhoff) not once, but twice. He gets his nutrition thru the tube and all of his medications crushed and pushed thru the tube as well. Naturally, he couldnt get any of that. Then when he went down for a procedure, I get a call from the radiologist informing me that my patient had decided to pull out his Quinton catheter, which is essentially a large IV that is inserted into the internal jugular and used for dialysis. Thus, my patient not only lost all IV access and could not get dialysis today, but I'm assuming was also bleeding profusely from the site. Thank goodness the radiologist decided to walk out and check on him, otherwise there's a good chance he could've lost quite a bit of blood laying there on the stretcher. Anyway, he was quite the handful the first 2 hours of my day. But then all of a sudden he did a 180 and was a completely different person in the afternoon. He was totally lucid, cracking jokes, compliant, and so pleasant. I swear, liver disease is one of the most puzzling things.
PS - totally random, but as I was driving out of the hospital parking lot today I saw a guy who I'm assuming is a Georgetown student, undergrad or maybe even med school. He was wearing khaki pants and a blue blazer.....and wearing a bright pink and purple backpack. It was awesome.
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