The Subinternship Begins!

So I started my Sub-I on Monday at Princeton in Internal Medicine.
Its going well.. got some interesting stuff. This place runs way different than RWJUH/St. Peters. There are no attending rounds, most patients are under private coverage, and we just call each attending. Our census is low (we have 4 (2 on their way out) now, 10 when i was on call on Wednesday)

So what have i seen..

40 yo h/x of carcinoid tumors started in the appendix now metastatic to lungs and mediastinum who came in for detox. She is really making an effort to get off ETOH which is good. She's got the carcinoid syndrome (flushing, diarrhea, wheezing) about 3 - 4 times a day. This is pretty rare (<10% with carcinoid tumors (which is a rare tumor)) She drank 1 GALLON/day!!!!

68 year old male with amyotrophic lateral sclerosis who passed away yesterday night
he came in with aspiration pneumonia, and was actually not doing so bad at all. This was a big surprise and a shock to all of us.

I actually watched a prouncement of death yesterday, for a 61 year old lady with metastatic pancreatic cancer.. which has a dismal prognosis. So she was DNR/palliative for last 3-4 days.. with no food or water. She was on the morphine drip, should've been no pain. My resident (really cool guy) said that you lose ur thrist/hunger drive so that's not really suffering.



We also got some pancreatitis and CHF and so on..