Date: 8/20/15

Location: 7 SW
I shadowed Dr. Farahmand this morning, which was excellent. We visited a patient who had
Wegners (pretty sure that was on house). Its an autoimmune disease, which made for some
interesting decisions on his part. He checked vitals first and saw that she had had a fever
overnight. He had to figure out why, even though it only a one degree difference. We went in, he
checked her lungs by auscultating, and heard crackles. He decided to start antibiotics right away.
I asked him why he had chosen to do that, since theres so much talk about superbugs these days.
He told me that he would rather overprescribe than risk a patient becoming septic, especially for
a patient whos already immune-compromised. He told me that in general, he definitely
overprescribes. He shared that he realized that he couldnt do his job properly if he remained
firm to the guidelines, and that he had to put the patients best interests before anything else.
The best part about shadowing Dr. Farahmand was, again, observing his bedside manner. He
comes in and says Its so great to see you again. Youre my favorite patient. She goes You
probably say that to everyone and he says Of course not. It was really sweet, and it definitely
brightened up the poor girls morning. Seeing how familiar and intimate he got with her, even
though he hadnt had years to get to know her, made me rethink the whole I can only develop
relationships if Im in a primary care practice. The fact that he was able to make such a
connection with her in the hospital setting makes me think that its all the more important that
people like Dr. Farahmand and hopefully me work in this setting. Because this is where people
need the human connection the most. Theyre at their most vulnerable here, not in the outpatient
setting. Maybe I should work in the hospital, as a hospitalist? It wouldnt be a terrible job. One
week on, one week off. Twelve hours shifts, sure, but those arent so bad (as Ill describe soon
enough).
On the more nitty gritty side of things, Dr. Farahmand also explained the good fun it is to balance
medications. Turns out that in addition to Wegners, this patient has an issue with her blood being
more prone to clotting, which puts her at risk of developing pulmonary embolism or a clot in her
extremities. This is why shes on a regimen of Cumedin (also known as Warfarin), which is an
anti-coagulant. Its a Vitamin K antagonist, and by its method of action it disrupts the coagulation
pathway or cascade. However, since this patient was going to have surgery, she couldnt be on
Cumedin because obviously they didnt want her to bleed out. So those are the kinds of
considerations that have to be made when taking care of patients. Its a lot of information to
digest and synthesize, but I really love the entire process. Its busy detective work, and its
always fun taking all this information thats been consumed and utilizing it in a meaningful way.
After shadowing in the morning, I worked my first 12 hour shift. It wasnt as bad as I thought it
would be. It was a relatively active day for me thank God. The nature of my volunteer position
makes it difficult to really fill up the day since I dont have to do charting and cant be constantly
taking care of patients like the nurses and NACs do. But nonetheless, I came out gloriously on
top of the 12 hour shift. Of course, then Don (one of the NACs) informs me about how residents
work over 24 hour shifts, which pulled the wind out of my sails somewhat. But Im proud of the
hard hours I put in all the same.

Also met a patient with xeroretinosa pigementosa. Its like the deterioration of the retina, which
leads to blindness. I felt absolutely terrible for this sweet woman, but she was taking her illness
in stride. She had a really great attitude about her disability.