Busy Friday on the Bone Marrow Transplant Service

Fridays at the hospital can be busy as people try to wrap up things for the weekend. Today was quite the example of that. 

I'm currently half way through my month on the BMT inpatient service. I woke up around 7:00 am and had a message and phone call from one of our junior fellows. She had admitted a patient with acute leukemia overnight. I got sign-out on this patient and our fellow did a great job! However, it was clear there were quite a few things to get done to take care of this patient today.

I got to work just in time for morning division rounds on Zoom. While I listened to conference, I pre-rounded at the computer. I had several existing patients to see, and I needed to take care of things for this leukemia patient. Then I got a message that a new patient was on the floor and needed admission orders. I put those in, finished pre-rounding, and made my way to the floor to round with the team.

After rounds there were many things to do. First, I did the bone marrow biopsy. I’ve done a lot of these procedures, but this one was harder than most. We got liquid but no marrow core. Once that wrapped up, I made my way back to my office to put in orders, write notes, and discharge two patients.

I got to the office and learned some bad news. I had told a different junior fellow she probably didn’t have to come in today because her clinic attending was out on vacation. However, because her peer had admitted this acute leukemia patient overnight and went home to sleep, it left one of the faculty clinics uncovered. The attending that didn’t have a fellow called our program director. This made our new fellow feel rotten. After all, she’s only been a fellow for a week. I imagined myself in her shoes, and I would have felt terrible. I emailed my program director to accept some responsibility for this miscommunication and apologize.

Next, I discharged patients, wrote notes, put in orders, went back to the floor to see patients in apheresis… but I still had things to do for our leukemia patient! I called the ICU doctors to help put in a central line and I reached out to nephrology to coordinate leukapheresis. In the midst of all that, I got a call from one of my clinic patients needing help with pain management care for the weekend.

Moments later I got a message from my attending that a patient was being direct admitted from clinic and needed a bone marrow biopsy. I put in orders for admission, wrote a quick H&P, and made my way to the floor to do the procedure. Fortunately, it went more smoothly than the BMB from the morning.

Around 4:30 pm I headed for the exit. I had a plane to catch. It’s my brother’s 32nd birthday weekend and I promised I’d come home to Texas for a visit.  I felt anxious about missing this flight all day as the work piled up. In total, I wrote many progress notes, admitted one patient, discharged two more patients, coordinated complex care for a patient with acute leukemia, and did two bone marrow biopsies. It was a successful day and I did the best I could for each patient, but I felt like I was jumping from one urgent situation to another all day. In addition, I still feel badly for my role in letting down one of my co-fellows this morning.

I love my job, my profession, and my program, but some days are harder than others.