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Residency, Year 1: Day 301

I was in the SICU for nephrology rounds the other day. We passed by one of the rooms and I saw Mrs. L's name at the door. That's weird, I thought to myself. She was one of the heme/onc patients that I had during March. She was a newly diagnosed AML. Initially, chemotherapy was delayed because she had some underlying respiratory issues, likely undiagnosed COPD. Once we got her on a good regimen for that, she underwent 7+3. The day before she was supposed to be discharged, she spiked a fever and began having a cough. By this time, she was neutropenic. Repeat blood cultures were negative. It wasn't until another patient was diagnosed with RSV (typically uncommon to cause very serious illness in adults, but immunocompromised patients are a whole different story) that we decided to check her. Well, what do you know? She was RSV positive. We kept treating her with expensive medications, and she held her own for a while, but eventually was intubated and sent to the MICU. Before my month was up, she returned to us, in a much weaker state, and I eventually signed her out to the next hematology intern. I saw that she was discharged home a week or so later.

So I was surprised when I saw her name outside of a SICU room. I went back through her records (which is probably against HIPAA regulations since she wasn't technically my patient anymore), and found that she was admitted a few days earlier with abdominal pain and nausea. A CT scan of her abdomen eventually showed an obstruction with possible perforation. The surgeons took her to the OR and found that was indeed what happened. Luckily for her, the perforation was contained in itself. But unluckily for her, most of her colon was removed.

I went to see her a couple of days later, just to send her my well wishes. It turns out that she was likely in remission for the AML, pending consolidation chemotherapy. Her bone marrow after induction chemo showed that she didn't have residual leukemia. I'm not sure if her bowel obstruction was from the chemo. For all I know, it could've happened even had she not gotten leukemia or chemotherapy. But it's rather unfortunate to get both, don't you think?