When I came on duty at 3 PM, it seemed like the most ordinary of days.
At the time I was a senior physician in a high-acuity emergency department
at Kaiser-Permanente Medical Center in Santa Clara, Calif, chair of the Peer
Review and Quality Improvement Program, and faculty in the Stanford-Kaiser
emergency medicine residency program.
I took sign-out from Dr Koscove, who told me, "I've got an 86-year-old
woman, Mrs Martinez, in room 17 with nausea, vomiting, and dehydration and
a history of metastatic lung cancer previously treated with chemotherapy and
radiation. She was discharged from the hospital two days ago for the same
thing. I controlled the nausea and vomiting with IVs and ordered a CT scan
to look for brain metastases and signs of increased intracranial pressure.
I told her you're taking over. You'll need to review the scan, and see if
she can tolerate oral fluids, before discharging her."
Feldstein BD. Toward Meaning. JAMA. 2001;286(11):1291-1292. doi:10.1001/jama.286.11.1291