Who takes charge of a Hep C Patient?

[Quinn1988]

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I will try to keep as brief as possible. When I was 14(22 now) my mother passed away from Hep C/Cirrhosis of the liver. While she was on the regular floor prior to admission to CICU, she saw multiple physcians daily. Once admitted to the CICU, she had an Infectious Disease specialist, Internitst, Vascular, Intensivist, Nephrologist, and Trauma Surgeon. First off, this is a clusterf**k of Physcians for a pt in the hospital. As I recall, I was unable to identify who was actually running that team. Today, I still am very unclear as to who was running that show. Who typically is the Captian of the team? Also, once in CICU, she was assigned a Sleep Physcian. What do they have to do with Internal Medicine? To rewind, the day prior to her being sent to CICU, I met with her Internist where I was informed my mother was very much in good shape and was very coherrent in discussion as well as not showing any signs of distress. A day later, I go to an appointment that I happend to have in the same hospital which was convienant because I stayed in the room with her. I get told basically she was walking to the bathroom, and next thing we know, she starts having a Grand Mal Seizure. Is this common for Hep C? Also, I was preped for what I was about to see and after that, I thought I was ready to see her. Wrong. Her appearance was very, very graphic, disturbing, and I will not go into details about what I saw because I do not want anyone else to have that mental image as it still haunts me to this day. Am I being overly sensitive in it still bothering me? Should I be over it by now? Reason I ask all this is because I still am unable to wrap my mind around some things. One, how is a decline in health of that magnitude within 24hrs possible? Two, how do I know I made the right choice in withdrawing life support? I was actually assisted by a trauma surgeon with coming to that choice in which he encouraged we focus on making her comfortable at this point. Seeing the discomfort she was in was heart breaking. Ironically enough, I want to practice medicine and have thought about Internal Medicine and Trauma on a number of occasions. I have very little understanding as to how Hep-C combined with Cirrhosis works and what it actually does which is why I think plays a role in me having a difficult time trying to make sense of that situation so if anyone out there could possibly break it down for me, it would be appriciated please and thanks.

 

[Instatewaiter]

I will try to keep as brief as possible. When I was 14(22 now) my mother passed away from Hep C/Cirrhosis of the liver. While she was on the regular floor prior to admission to CICU, she saw multiple physcians daily. Once admitted to the CICU, she had an Infectious Disease specialist, Internitst, Vascular, Intensivist, Nephrologist, and Trauma Surgeon. First off, this is a clusterf**k of Physcians for a pt in the hospital. As I recall, I was unable to identify who was actually running that team. Today, I still am very unclear as to who was running that show. Who typically is the Captian of the team? Also, once in CICU, she was assigned a Sleep Physcian. What do they have to do with Internal Medicine? To rewind, the day prior to her being sent to CICU, I met with her Internist where I was informed my mother was very much in good shape and was very coherrent in discussion as well as not showing any signs of distress. A day later, I go to an appointment that I happend to have in the same hospital which was convienant because I stayed in the room with her. I get told basically she was walking to the bathroom, and next thing we know, she starts having a Grand Mal Seizure. Is this common for Hep C? Also, I was preped for what I was about to see and after that, I thought I was ready to see her. Wrong. Her appearance was very, very graphic, disturbing, and I will not go into details about what I saw because I do not want anyone else to have that mental image as it still haunts me to this day. Am I being overly sensitive in it still bothering me? Should I be over it by now? Reason I ask all this is because I still am unable to wrap my mind around some things. One, how is a decline in health of that magnitude within 24hrs possible? Two, how do I know I made the right choice in withdrawing life support? I was actually assisted by a trauma surgeon with coming to that choice in which he encouraged we focus on making her comfortable at this point. Seeing the discomfort she was in was heart breaking. Ironically enough, I want to practice medicine and have thought about Internal Medicine and Trauma on a number of occasions. I have very little understanding as to how Hep-C combined with Cirrhosis works and what it actually does which is why I think plays a role in me having a difficult time trying to make sense of that situation so if anyone out there could possibly break it down for me, it would be appriciated please and thanks.

The physician in charge of a patient in an ICU (a closed ICU) tends to be the ICU attending. The other doctors are consultants who the ICU attending asks to come and give recommendations regarding their specific organ (ie Hepatology for the liver, renal for the kidneys etc). Often times the consultants are not needed but for very sick patients (esp those on dialysis and those with cirrhosis) the help of consultants helps improve care.

Cirrhotic patients turn very quickly and go from walkie/talkie around a normal hospital ward to intubated in an ICU.

Having to make life and death decisions is difficult. The patients in the ICU are very sick and have a high mortality rate. 20% die. Cirrhotic patients have much, much higher mortality rates. Some studies say up to 70% of cirrhotic patients admitted to the ICU die. We don't have the information to tell you how sick she was but it seems like the decision was carefully thought out and you probably came to the logical conclusion.

 

[Quinn1988]

The physician in charge of a patient in an ICU (a closed ICU) tends to be the ICU attending. The other doctors are consultants who the ICU attending asks to come and give recommendations regarding their specific organ (ie Hepatology for the liver, renal for the kidneys etc). Often times the consultants are not needed but for very sick patients (esp those on dialysis and those with cirrhosis) the help of consultants helps improve care.

Cirrhotic patients turn very quickly and go from walkie/talkie around a normal hospital ward to intubated in an ICU.

Having to make life and death decisions is difficult. The patients in the ICU are very sick and have a high mortality rate. 20% die. Cirrhotic patients have much, much higher mortality rates. Some studies say up to 70% of cirrhotic patients admitted to the ICU die. We don't have the information to tell you how sick she was but it seems like the decision was carefully thought out and you probably came to the logical conclusion.

I know the ICU Attending is who runs that team, I was more asking specifics as far as what type of physcian? (Infectious Disease, Nephrology, Internist etc etc) Or will it just depend on the given situation as to what type of provider runs the team? Just for clarification, it is common to see a Cirrhotic patient go down hill of that fashion and in such a short amount of time? Speaking for myself anyway, it was literally seeing the best of both worlds on a great outcome, and a very bad one within a day. I find the difference in mortality numbers between one who is Cirrhotic and one who isn't very interesting. Is that illness also known to cause such violent seizures? Does that deem the patient as going into renal failure from the start? Also, I recall she somehow developed a qtr size hole in her leg from where an infected area had ruptured through while she was in the ICU. What is that one all about? Is it accurate to expect the prognosis to be poor as the number of physcians involved start to increase? Just out of curiosity, what purpose would a sleep specialist serve at that point? Just asking for an opinion as I know the answer will vary, would it be unrealistic to have expected a full recovery at that point?

 

[Instatewaiter]

I know the ICU Attending is who runs that team, I was more asking specifics as far as what type of physcian? (Infectious Disease, Nephrology, Internist etc etc) Or will it just depend on the given situation as to what type of provider runs the team? Just for clarification, it is common to see a Cirrhotic patient go down hill of that fashion and in such a short amount of time? Speaking for myself anyway, it was literally seeing the best of both worlds on a great outcome, and a very bad one within a day. I find the difference in mortality numbers between one who is Cirrhotic and one who isn't very interesting. Is that illness also known to cause such violent seizures? Does that deem the patient as going into renal failure from the start? Also, I recall she somehow developed a qtr size hole in her leg from where an infected area had ruptured through while she was in the ICU. What is that one all about? Is it accurate to expect the prognosis to be poor as the number of physcians involved start to increase? Just out of curiosity, what purpose would a sleep specialist serve at that point? Just asking for an opinion as I know the answer will vary, would it be unrealistic to have expected a full recovery at that point?

ICU attendings tend to be Critical Care physicians.

Cirrhotics crash very fast. A 180 in a day is not uncommon.

Cirrhosis and renal failure often go hand in hand.

Seizures could be from a hundred different causes, many of which may be related to cirrhosis.

Don't kow about the infection without having seen it and known the circumstances.

Sicker patients have more doctors involved because more organ systems are failing. So I would expect that the more specialists that are involved the worse the disease is and the worse the patient will probably do.

I have no idea about the sleep specialist.

It would be unrealistic to expect a full recovery, and likely a discharge from the hospital, given what I have heard thus far- but I wasn't her doctor so I can't know for certain. Again, cirrhotics do very, very poorly.

 

[Quinn1988]

ICU attendings tend to be Critical Care physicians.

Cirrhotics crash very fast. A 180 in a day is not uncommon.

Cirrhosis and renal failure often go hand in hand.

Seizures could be from a hundred different causes, many of which may be related to cirrhosis.

Don't kow about the infection without having seen it and known the circumstances.

Sicker patients have more doctors involved because more organ systems are failing. So I would expect that the more specialists that are involved the worse the disease is and the worse the patient will probably do.

I have no idea about the sleep specialist.

It would be unrealistic to expect a full recovery, and likely a discharge from the hospital, given what I have heard thus far- but I wasn't her doctor so I can't know for certain. Again, cirrhotics do very, very poorly.

Wow so Cirrhotics in a sense have a poor enough chance of recovery according to studies, then grouped with other illnesses, I hate to say it this way but it seems like understanding that now that whole situation was pretty much an open and shut case. I do understand the difficulty in trying to explain how that situation works without having been there just because it clearly is going to effect people differently. I can just say from being there that whole situation was a mess from the start and was on a rapid decline. I am just more interested in trying to figure out what it was we were truly dealing with big picture wise. Thanks for explaining some of that. It gives me a much better idea now.