Ward Rounds

My month here has been long, crazy ward rounds everyday. We did not finish until mid afternoon most days. To me, you spend an hour maybe two hours, but then you go to the OR. Not so with medicine doctors. All the same these have been extremely long ward rounds. We would consider every physical finding, every test, what test we should order next, and then what exactly is the diagnosis and how are we going to treat it? Most the time there is a muddle of things going on with patients and it is hard to pick out all the problems and what to focus on and such.

Yesterday we had our last patient to round on. Mr. E. He came into our ward with uremia encephalopathy. His urea was 40 for those that follow labs. He was a vascular path without legs, he was weak, quite confused, and aggressive. Last week he took regular swings at me on some days and then would invite me to sit down and talk nonsense for a while. He was entertaining. He had some problems with a urinary tract infection while with us, and still had all his medical problems. We walked into his room and he was laying there in bed dead.
It was not a shock, a surprise, or anything out of the ordinary really. He lifeless body layed there in bed. He had been alive only a few short hours before and was fighting with the nurse because he did not want his oxygen mask on. His swing was gone from his arms, his eyes fixed and dilated. We listened to his heart for a full minute, without any sounds, no pulses. His hopping around in bed with his leg stumps had ceased, his incomplete sentences, accusations, and loyal Britain singing was gone. I was no longer the dirty American trying to fool him. He was there helpless, alone, and lifeless.
His partner was an American, she could always calm him down, and introduced herself to me as, "the love of his life" I could not take to heart is anti US American names for me. He had three wonderful children and I am sure they will remember him as the fiesty man he was even at death. I really enjoyed him for the time that I had with him.
There was nothing to do but say a prayer over him quietly, cover his beautiful body up with a sheet, inform his wife and then we went to lunch. Life goes on, there continues to be another crazy patient that needs looking after and perhaps a place for him to die as well. He continues with me reminding me not every angry word or act of rage is directed directly at me. Most of the time it is just frustration reaching out for contact and needs my skills as a medical doctor if there is anything that can be done. And when there is not then it is to help him die peacefully.