When I was an intern, my upper level resident shared a valuable lesson she learned in a tragic way. She had a patient who was very sick and needed serious medications to keep the blood pressure in an acceptable range. All night long she would increase the medication, get good results, and then the blood pressure would drop some more. She repeated the cycle many times throughout the night, feeling quite pleased she had kept the patient alive through the night. When the attending came in and assessed the patient, he informed my upper level resident that although she had successfully maintained the blood pressure, she had killed the bowel in the process and the patient would die soon. The medication works by clamping down the blood vessels in the arms, legs, and bowel, leaving more blood to stay in the heart and get to the brain. Not bad when it's only the arms and legs, but once you stop sending blood to the bowel, it dies, and that's not compatible with life. My upper level resident felt horrible. The attending went on to say it was OK, the patient was in a hopeless situation either way, but that there's a valuable lesson to be learned: Don't get so focused on numbers that you forget to look at the patient. (I hope that my non-medical friends who read this don't find this story too disturbing, but I remind you that death is very natural, and it happens to everyone. There are a lot of very important lessons to learn in medicine and in life related to someone's death. The doctors involved are not uncaring, but when you work in critical care, you know a lot of patients are going to die, and it's a valuable time to teach.)
Well, fortunately J is not in a grave situation with his health. He will walk out of the hospital when this week is finally over. However, last night about 3 am, I was woken to the nurse's voice trying to convince J to take two medicines. I very sleepily asked what was happening. They found that J's urine pH had dropped below our target range (barely below mind you). The middle-of-the-night resident decided a number was out of place and needed to be fixed. J also had a mildly elevated temperature of 100 degrees. His nurse decided that had to be treated with Tylenol. J would have slept through the night, none-the-wiser of both the mild fever and the low urine pH, but since there were two numbers out of the target range, he needed treatment. Remember, he HATES taking medicine, especially pills, and shots, and liquid medicine that tastes bad, and IV injections. The pill they wanted to give, he will only take with Key Lime flavored Greek Yogurt. We had none at the hospital in the middle of the night. This morning it took about 30 minutes to finally get him to take the pill with the yogurt I retrieved from home. I (and I don't know if I sounded kind or grumpy or obnoxious) told the nurse there was no reason to force a pill down in the middle of the night and that this was a daytime issue, not a middle of the night issue. She said she could have the resident come and talk to me. I kept quiet, but I wanted to say, "Only if you want me to yell at him for thinking a number is more important than the patient; he needs sleep more than a slight adjustment to the pH." The resident never came. Victory. Although I was so annoyed with the situation I couldn't fall asleep for another half hour. Ruined the victory.
J took the Tylenol for the fever. Sadly, that is a battle I have never won. I can not convince nurses or mothers that a fever is totally normal, it's the body's mechanism for fighting infection, and you only should consider treating it when it makes the person miserable (often, but not always). Figure out why there is a fever, but don't lose sight of the patient by getting focused on the number.
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