dialysis machine photo from here
October was my nephrology rotation, which means we took care of all of the patients who had any sort of kidney problems.
I was a part of a consult service which means we checked in on all of our patients every day but only managed the problems with kidneys. Most people, for example, had other problems as well. For example, a patient may be admitted to the hospital for pneumonia but we are needed to help manage their dialysis treatments and the dosing of medications appropriate when a patient has kidney failure.
Dialysis was a big part of our day to day. The dialysis machine is the photo in this post. Your kidneys work to filter toxins out of your body by moving toxins out of your body and into your urine for excretion. The toxins come from breakdown products of the foods you eat or the breakdown products in the metabolism of your body. Your kidneys are super smart and efficient, they are constantly adapting as needed based on whatever environment you put them in. They also help manage blood pressures and adjust this as your body requires. They manage electrolytes too, if these are not balanced you can have life threatening brain and heart events. When someone's kidneys are not working, it is life threatening in many ways and we hook them up to a machine called the dialysis machine. A dialysis machine is a machine that "cleans your blood" just like your kidneys would if they would work. It can also remove excess fluid, since normal kidneys would be able to do this. You "hook up" the machine into vessels of your body and take off blood a little at a time, "clean it", and put the blood back in your body. This process takes around 3-4 hours. Patients with severe kidney disease are often on dialysis three times a week and visit an outpatient center to have this done. In the hospital we have a room for them where we manage their dialysis needs during their stay.
7:30 - 8:15 a.m.
Look at all of my patients' labs from the morning, their imaging, and the plans from other doctors (since we are just one part of the team). I always look at the amount of liquids (from an IV or what the patient drank) that went IN to the patient and compare this to how much fluid came out (urine) to assess if it is appropriate. Sometimes we give patients "water pills" and expect them to lose a lot of fluid in their urine. In the hospital we often hook people up to IVs for a few days and sometimes they will get fluid overloaded so we need to give them these water pills.
8:15-9:00 a.m.
Go peek into all of my patients' rooms and see if there's anything urgent that needs ordered right away. I assess their fluid status (I look at their legs to see if they are swollen and I listen to their lungs to see if they sound like theirs fluid in there).
9:00 a.m. - Noon
Round with my attending and visit all of the patients again. Place more orders in the computer.
Lunch
1:00 - 4:00 p.m.
Check in with other doctors about questions we have with patients we share. I also would see new patients with kidney disease who come into the ED, or develop a temporary kidney injury while in the hospital, or who are transferred and have any kidney problems. I often had time to study in the afternoons too.
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