poured out before bed
“So, this is our 69yo M with DM2 with neuropathy, retinopathy, and nephropathy, on hospital day #5 for hyperglycemic hyperosmolar state with seizures, acute on chronic kidney injury, and sepsis. On admission, the patient suffered a witnessed seizure, presumed secondary to the HHS; he has had no subseqent seizures on the current antiepileptic regimen. Also on admission he met criteria for septic shock and had blood culturesx2 positive for MRSA. He is on day #5 of vanc/zosyn and has been afebrile with stable and normal vital signs for the last 4 days; repeat blood culturesx2 so far negative. Admission creatinine was 3.1, his baseline running around 1.9-2.1; today’s creatinine is 2.3, and he continues to make appropriate volumes of urine. His diabetic control has been poor, with average blood sugar at 313. This is likely secondary to his refusal of the prescribed sliding scale insulin, as well as the jumbo packages of oreos and tootsie rolls his wife has been smuggling him daily. With regard to his diabetic complications, his neuropathy is poorly controlled on the current gabapentin regimen, with the patient reporting constant burning of bilateral lower extremetries to the level of the malleoli. Urine analysis shows overt proteinuria, so there has been progression of his previously observed microalbuminuria. His last ophtho appointment was 3 years ago, at which time his retinopathy was thought to be moderate, but stable. The patient denies decline in visual acuity since that time. However, I feel his retinopathy is likely now more severe, as he told me today he felt I had the most nicely-shaped tuchus he’d ever seen on a woman. I would recommend that we increase his 70/30 insulin from the current 30 units QAM and-“
Suddenly, from his deep, table-rounds induced state of pan-loathing, the attending – normally peremptory to rude, albeit rather detached – giggle-snorts and begins a slow, rising guffaw that sends the rest of the team into peals of laughter. He claps my shoulder.
“You’re alright, kid,” comes a voice I’ve never before heard in conversational tones. “What was your name again?”
Endocrine Score Card
* Mullberry – 100
* Unbelievably boring endocrine rounds with unfathomably up-tight and often positively unengageable attending – 0