Day 3

Today was a short day as I logged four hours. Their were no clinic patients scheduled this morning so I rolled in at about one. Again I rotated with Viroslav this time in the company of dr lee. Their was a huge rush as coincidentally four patients were schedulednright on top of one and other. Two with ALS, one with polio and scoliosis, one with muscular dystrophy and one with a spinal cord injury. Then first guy we saw had polio and by looking at his numbers co2 levels, ph, capacity etc. It was pretty clear this guy was getting progressively worse. He had a ph of 7.3 (normal is 7.4) co2 levels were way up, and his lung capacity was about 1.03 liters (that's awful) so this guy who has been a patient of viroslav's for twenty years is basically now considered as having respiratory failure. He's going to need to be on ventilation 24/7. He also needed a particular type of power chair which Medicare wouldn't cover, (btw Medicare absolutely blows) needless to say Viroslav was not happy about the chair. The next three patients were very quick all were getting their trache and feeding tubes changed. Last and perhaps the most memorable patient ive seen all week. Middle aged married male with ALS, apparently very successful was a young CEO moved here from the east coast and diagnosed with ALS. Obviously the patient is emotionally destroyed, apparently last visit there was lots of crying (there was this time too) the options for these people are terrible and the disease is an absolute death sentence and perhaps one of the worst ways to go that I can think of. The helplessness is pretty apparent, I'm definitely going to touch on ALS in my presentation to the faculty members next week.