Normally, Drs. Elnachef and Pham/Arquilla cover for me, the latter doing St. Joseph Hospital where most of my inpatient work occurs. Moh looks after the routine calls and directs the patients to where they should be, with the help of my assistants/secretaries, Sally and Alejandra. It works well enough for me to get away.
However, this time, Drs. Pham and Arquilla were both going out of town on the same day, and it was the day that I was leaving
so, enter a 4th doctor, Sandeep Dang. He was gracious in saying that he would cover for the three of us.
At 9PM (21:00) as I picked up the phone to swign out to Dang and Elnachef, the operator said that I had a call from St. Joe's ER. Not a good omen!
A chronic dialysis patient had a K+ of 6.8, and nausea and vommiting. She needed an emergency dialysis, and after the kindness that I was receiving, I couldn't dump this complicated patient on Dr. Dang, who has his own super busy practice and was about to get Pham/Arquilla's super busy practice dumped on him. Moh is not on the staff of St. Joes so it was up to me.
She was very interesting! Vomiting means loss of acid, and an alkalotic state with a high CO2, which she had, alkalosis brings the K+ down and hers was critically high. Vomiting also brings dehydration, but she had a BNP of >5000, generally indicating heart failure, which doesn't generally occur if your dehydrated. On exam, she wasn't dehydrated, and there were no signs of congestive heart failure. Her chest x-ray showed pretty clear lung fields. She actually looked pretty good.
Other lab tests were similarly bizarre, such as a Hgb of 17... just the opposite of anemia, and a serum albumin of 5.9 and total protein of 10. Both way too high. Together, they point to dehydration, but she had no signs of dehydration. I arranged for her emergency dialysis, and on the way home, now 23:30, I dropped by Davita Orange Dialysis for 5 patients on nocturnal 6 hour dialysis, half of whom were asleep, so I didn't waken them. I had a a little trouble falling asleep thinking of the contradictions and feeling a little bad to leave the solution in the hands of a very busy young doctor, but he can handle it.
Then, I set both of our iPhones as alarms, and my PDA as a third alarm. This worked just fine. We were packed long in advance and all seemed well. New Nikon camera and its electrics, Macbook, Canon Elph, iPhone, and even old Palm Zire PDA... and my iPod and speaker.
Today, I discovered that the Apple AC/DC transformer had been left behind! Closest Apple store in Jacksonville, but we will find one in Ft. Lauderdale tomorrow, when we one way rent a car from Hertz at St. Simons Island airport and drive the 412 miles, aided by my Garmin, to the Courtyard in Dania Beach for an overnight, and then on Saturday, we board the Eurodam, our old friend from our 2007 Baltic cruise, for the Nation Cruise Seminar, with Howard Dean, Robert Scheer and many others, including a medical anthropologist. Our ports include Grand Turk, San Juan, Puerto Rico, St. Thomas,Half Moon Cay in the Bahamas.
We are being treated so royally by the Kadems that we feel so special. Lin is out shopping with Jayne, heaven help me, and I'm pounding Hunter's PC. I've taken photos of our accommodations, but I don't want to publish them for fear of creating ill will at the Ritz Carleton, Singapore, our previous standard for self-indulgence.