An email.

I got an email last night saying I was a possible bone marrow match. I was so excited I couldn't fall asleep and then I went through my 12 hour shift on 4 hours sleep.

Really, I should say I found an email last night. It was already a day old. One of my patients had discharged the night before, and the other was tuned up for discharge today, so pre-rounding was a snap. With the extra time, I called the coordinator at 7AM, but low and behold, they keep regular office hours. 8:30-5, M-F. Ok, leave a message. Then 20 minutes before rounds, the intern tells me we've had a holding note to work up a new patient since 5AM. Would I like it?

Well, yes. Actually, I really would.

Learning medicine is a lot of figuring out the culture as you go. Now I know to search for holding notes. Have no idea where they're stored, but I know to hunt them down if I've got down time. And I'm kicking my ass about that one.

Between rounds, more rounds, lectures from the fellow, noon lectures, working up the patient, writing a swollen med-student style H+P, coordinating discharge for the other patient, and then getting a transfer, 5 o'clock came and smoothly rolled by before I ever had a chance to try to call that number again. I feel a bit guilty.

Yeah, in the typical hospital pattern, something gets pushed to the side for something else, and it happened on a Friday. That office is not going to be open over the weekend. It's 8:30-5:00, M-F. So I can't call until Monday. The call is just for coordination, I'm not really sure where they'll want to do the HLA typing or how long it will take to draw/run those labs. I'm assuming doing it at our center is fine.

But I'm thinking that somewhere out there is a 33yoM, with AML who might need some marrow. And I can't help but think of one of my first patients on the heme-onc floor who had AML and was fighting for his life, on an impossible chemo regimen. He was mine for the whole month. And the previous month he belonged to another classmate. Every day you walk in to update someone on their counts, just holding out in a state of emotional stead-fast for them to return to themselves, you would do nothing short of killing to get them a better chance. Then you leave the service and they disappear from you.

My next rotation was vascular surgery, and I was only able to visit him once on my post call day. I heard through the grape vine they got to the next stage in his treatment. But I really don't know what happened to my patient long term.

So I think about this other young guy, who is obviously not the same person I snuck brownies to on the heme-onc floor because I couldn't stand the fact that he was going crump any day coming, and have his string of last meals be hospital food. This isn't the same guy. He's not "my patient".

But the same diagnosis of acute myeloid leukemia is really hitting me. And I've got that same fierce reaction when someone is assigned to me. They are mine. It's my responsibility to make sure they don't fall through the cracks. That's my role as a med student. Being thorough. Until there is nothing left for me to do for them, I can not rest. Seriously. I don't sleep right unless I do right.

I have to follow up on this guy. This HLA typing needs to get coordinated.