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Am Fam Physician. 2023;108(4):404

Author disclosure: No relevant financial relationships.

8:00 a.m.

I begin hospital rounds with three residents, one medical student, and our pharmacy team.

8:15 a.m.

We see a young male patient with substance use disorder who is being treated with intravenous antibiotics for endocarditis. He is almost weaned off oxycodone and thinks he can maintain sobriety. He has a good sense of humor, and everyone on our team enjoys visiting with him.

8:45 a.m.

Our next patient is a retired surgeon who likely has a recurrence of lung cancer. She will be discharged home today, and I joke that I do not want to see her back at the hospital unless she is seeing patients. She smiles. As we leave, just like every time we see her, she thanks us.

10:00 a.m.

Three of us put on N95 masks, gowns, and gloves to see our patient with COVID-19. His hemoglobin level is dropping, but we are not sure why. We discuss options for further workup. We suspect the drop in hemoglobin is secondary to the fluids he has received. Because his vital signs are stable, we opt to recheck his hemoglobin level later in the afternoon.

10:30 a.m.

We have been asked to evaluate a young teenage patient with tachycardia who has multiple foot and leg fractures after a dirt bike crash. I ask if he plans to get back on his dirt bike once he has healed, and he answers with an emphatic, “Yes!” We suspect his tachycardia is caused by pain and dehydration, but his score on the Wells criteria for pulmonary embolism is a 3 (moderate risk), so we order computed tomographic angiography of the chest.

2:00 p.m.

A resident and I participate in an interdisciplinary meeting with palliative care, hospice, ethics, pulmonology, and radiation oncology to discuss care planning for a patient with metastatic lung cancer.

3:30 p.m.

I sit outside the hospital on a bus stop bench with a resident and our patient with endocarditis. He has just left the hospital against medical advice. We are trying to convince him to come back because he will likely die without completing his antibiotic course. With tears in his eyes, he thanks us for caring about him so much. He gets on the bus and leaves. I hope he comes back.

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This series is coordinated by Jennifer Middleton, MD, assistant medical editor.

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